A child with autism or a disability and the visa health requirement: the cost test, the exemption, and the waiver

MARN 1576536

What the health requirement is

Almost every visa requires each applicant, and each member of the applicant's family unit, to meet a public interest criterion on health: that the person is free from a disease or condition that is a threat to public health, and free from a disease or condition that would be likely to result in significant cost to the Australian community in health care or community services, or to prejudice the access of Australians to those services. The second limb is the one a child with a disability meets. The assessment is made by a Medical Officer of the Commonwealth on the panel doctor's examination and the specialist reports, and it is an estimate of cost, not a judgment of the child. The health waiver guide sets out the criterion in full.

How a child's condition is costed

The Medical Officer identifies the condition and its severity from the reports, then estimates the health care and community services a hypothetical person with that condition would use over the assessment period, which for a permanent visa is capped at ten years, or until the age of eighteen for some childhood conditions assessed to resolve, and for a temporary visa is the length of the stay. The services are costed at standard public rates: specialist and allied health care, medication, therapy and disability supports of the kind the NDIS funds, respite, and, where the condition requires it, special education or in-class support. The total is compared with the significant cost threshold, currently AUD86,000, revised periodically. What is not in the calculation is the family: their private health insurance, their savings, their undertaking to pay privately, and the fact that a temporary visa holder is not eligible for the NDIS at all. The test asks what the condition would cost the community if the person used the services available, and the family's means go to the waiver, not to the assessment.

Autism, and the conditions most often assessed

• Autism spectrum disorder. The commonest case. Level 1 with no funded supports and mainstream schooling is often costed under the threshold; level 2 or 3, or any level with funded therapy, a support worker or a special school, is usually over it. The Medical Officer reads the level, the adaptive functioning scores and the current supports, so a report that states "requires substantial support" states the cost.
• Intellectual disability and developmental delay. Costed on the degree and on the education support required; a global developmental delay in a young child is often assessed over the threshold because of the years of support ahead.
• Down syndrome. Usually over the threshold on the combination of health, therapy and education costs, and almost always a waiver case.
• Cerebral palsy and physical disabilities. Costed on mobility, equipment, therapy and surgery; the wide range of severity makes the reports decisive.
• Hearing and vision impairment. Costed on devices, implants, interpreting and education support; a child with a cochlear implant already fitted is costed on maintenance rather than the implant.
• ADHD, dyslexia and learning difficulties. Usually under the threshold unless combined with another condition or requiring funded school support.
• Chronic illness, type 1 diabetes, epilepsy, kidney disease, which are costed on treatment and are over the threshold where ongoing hospital care or dialysis is involved.

One fails all

The criterion applies to every member of the family unit of the primary applicant, whether or not they are included in the application and whether or not they intend to migrate, and a family member who does not meet it causes the primary applicant not to meet it. A family cannot leave the child off the application to avoid the assessment; the child is examined as a non-migrating dependant and the result is the same. The only ways through are that the child is under the threshold, that the child is exempt, or that the visa carries a waiver and the waiver is granted. The family unit guide explains who is counted.

The exemption for children born in Australia

Amendments that commenced on 16 October 2024 removed the significant-cost and prejudice-to-access limbs from the health requirement for a child under 18 who was born in Australia, in most visa applications. The child is still examined and must still be free of a public health threat, but the cost of a condition is no longer a ground. For a family on a temporary visa whose child was born here and later diagnosed, the diagnosis no longer fails the permanent application. The exemption turns on the birthplace and the age at the time the criterion is assessed, and a child born overseas, however long they have lived in Australia, is assessed in the ordinary way. The child born in Australia guide covers the related rules.

Which visas have a waiver

The health criterion comes in two forms. PIC 4005 has no waiver: an applicant or family member assessed over the threshold fails, and the application is refused. It applies to the points-tested 189, 190 and 491, the parent visas, most visitor and working holiday visas, and the 485 in some cases. PIC 4007 contains a waiver: the Department may waive the significant-cost limb if satisfied that the cost would not be undue, having regard to the applicant's circumstances and the benefit to Australia. It applies to the employer-sponsored 482, 186 and 494, the partner visas at both stages, the child visas, most student visas, and others. For a family whose child is over the threshold, the visa is chosen with this table in hand: an employer sponsorship with a waiver is a path, a points-tested application without one is a refusal. The employer route is the one most families with a diagnosis end up on.

How the waiver is decided

When a family member is assessed over the threshold on a PIC 4007 visa, the Department writes inviting the applicant to address the waiver, and the submission answers one question: whether the estimated cost would be undue, weighed against the applicant's circumstances and the benefit of the grant to Australia. The matters that carry weight are the compelling and compassionate circumstances of the family, the primary applicant's occupation and the shortage it fills, the family's income and the tax it pays, the family's capacity and demonstrated willingness to meet the child's costs privately, the extent to which the child will actually use publicly funded services, the ties to Australia, and the consequences of refusal for the child and the family, including the services available in the home country. The decision is discretionary, the Department refuses more waivers than it grants, and a refusal is reviewable at the Tribunal where the applicant is in Australia, which decides the waiver afresh. Ministerial intervention is the last resort after that: the intervention guide.

The evidence that wins

• Specialist reports that describe functioning, not labels. A paediatrician's or psychologist's report that sets out what the child can do, the supports actually used, the prognosis, and a reasoned view of future needs, against the generic costing the Medical Officer otherwise applies. Where the child has improved, the reports say so with dates.
• The actual cost of the supports the family uses, with invoices, and the family's record of paying them privately, which addresses undue cost directly.
• The family's finances: income, assets, insurance, and a budget showing the child's costs met without public services, signed as an undertaking where the family is prepared to give one.
• The primary applicant's contribution: the occupation, the employer's letter on the position and the shortage, the tax paid, and the economic case for the grant.
• The school's evidence on the child's placement and the support provided, which fixes the education cost rather than leaving it to estimate.
• The circumstances: time in Australia, siblings who are citizens, the family's community, and what refusal would mean for the child, including a statement on the services available where the family would go.

A waiver submission assembled after the Department's letter, inside the 28 days usually given, is weaker than one planned before lodgement, when the reports can be commissioned with the test in mind.

Review, and the order to do things in

1. Establish the diagnosis, the level and the supports as the reports state them, and estimate the costing against the threshold.
2. Check the exemption: born in Australia, under 18.
3. If over the threshold and not exempt, choose a visa with a waiver, which may mean an employer route rather than a points route.
4. Commission the reports and gather the financial and contribution evidence before lodging, so that the waiver submission is ready when the invitation arrives.
5. If refused on health, lodge for review within the period on the letter, where the applicant is in Australia; the Tribunal reconsiders the waiver on fresh evidence.

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General information only, current at October 2026; not advice on your own case. Public Interest Criteria 4005 and 4007 in Schedule 4 to the Migration Regulations 1994, as amended with effect from 16 October 2024, and the Department’s published significant cost threshold, as at the date above; the threshold and the costing methodology are revised by the Department and the figure stated is the one published at the date above. Outcomes depend on the Department’s assessment of each application; no registered migration agent can guarantee a result (Code of Conduct, Migration Agents Regulations). Keshab Chapagain, MARN 1576536.