The Chronic Pediatric Disease Medical Care Recipient Certificate

Shounikaman Tokuteishippei Iryou Jukyuusha Shou / 小児慢性特定疾病医療受給者証

This program is not specifically for children with disabilities, but many children with disabilities qualify for it without their families knowing. If your child has epilepsy (tenkan / てんかん), a congenital heart condition, Down syndrome or another chromosomal condition, a neurological or muscular condition, a metabolic disorder, or any other chronic condition that requires ongoing medical treatment, their condition may be on the national list of designated chronic pediatric diseases. Many children who hold an intellectual disability handbook (ryouiku techou / 療育手帳) or a physical disability handbook (shintai shougaisha techou / 身体障害者手帳, also called a disability certificate) also have a chronic condition that qualifies. If yours does, this program can significantly reduce your medical costs.

The chronic pediatric disease medical fee subsidy (shounikaman tokuteishippei iryouhi josei seido / 小児慢性特定疾病医療費助成制度) is a national program established under the Child Welfare Act (jidou fukushi hou / 児童福祉法). It covers approximately 800 designated diseases and applies across all of Japan. It is separate from the independence support medical care recipient certificate (jiritsu shien iryou jukyuusha shou / 自立支援医療受給者証) and the severely disabled persons medical fee subsidy (juudo shinshin shougaisha iryouhi josei seido / 重度心身障害者医療費助成制度), though your child may qualify for more than one of these programs and they can be used together.

What Does This Program Do?

When your child is approved, the program reduces the medical costs for treatment of the designated chronic disease at designated medical institutions (shitei shounikaman tokuteishippei iryou kikan / 指定小児慢性特定疾病医療機関). You pay a reduced copay up to an income-based monthly cap, and the remaining costs are covered by public funds.

The coverage applies to insurance-covered medical expenses, including outpatient visits, hospitalization, prescriptions, and visiting nurse services, as long as they are related to the designated disease and provided at a designated medical institution. The program does not cover non-insurance items or treatment at non-designated institutions (except in emergencies).

For current copay cap amounts by income level, check with your prefecture or see the prefectural pages linked in the Useful Resources section below.

Who Is Eligible?

Your child must meet two conditions:

Age: Under 18 years old. If your child is already certified at age 18 and still requires treatment, coverage can be extended until age 20. This extension is critical: if the certification lapses after age 18, even briefly, your child cannot reapply. Do not let the recipient certificate expire after your child turns 18 if they still need treatment.

Disease: Your child must have one of the designated chronic pediatric diseases (shounikaman tokuteishippei / 小児慢性特定疾病) and their condition must meet the severity criteria set by the national government.

The designated diseases are organized into 16 disease groups, including malignant tumors, chronic kidney disease, chronic respiratory disease, chronic heart disease, endocrine diseases, metabolic diseases, blood diseases, immune diseases, neurological and muscular diseases, chronic digestive diseases, chromosomal and genetic conditions, skin diseases, bone and connective tissue diseases, vascular diseases, and congenital malformation syndromes.

For families of children with disabilities, the most commonly relevant groups are neurological and muscular diseases (which includes epilepsy, muscular dystrophies, and cerebral conditions), chromosomal and genetic conditions (which includes Down syndrome and other chromosomal disorders), chronic heart disease (which includes congenital heart defects common in children with genetic conditions), and metabolic diseases (which includes conditions that can cause intellectual disability if untreated).

The full disease list and severity criteria are published on the Chronic Pediatric Disease Information Center (Shounikaman Tokuteishippei Jouhou Sentaa / 小児慢性特定疾病情報センター) website. Check the link in the Useful Resources section below. Your child’s specialist doctor can also tell you whether they qualify.

How to Apply

This program is administered by prefectures, designated cities, and core cities. The application is submitted to your prefectural health center (hokenjo / 保健所) or your city’s designated application window. This is not the same office as the disability welfare desk (shougai fukushi ka / 障害福祉課) at your ward office.

You will need an application form (available from the health center or their website), a medical opinion form (iryou ikensho / 医療意見書) completed by a designated doctor (shitei i / 指定医) treating your child, your child’s health insurance card, your My Number card or notification, income-related documents to determine your copay category, a household survey form (setai chousa hyou / 世帯調査票), and the names of the designated medical institutions where your child will receive treatment.

The medical opinion form is specific to your child’s disease and can be downloaded from the Chronic Pediatric Disease Information Center website. There is usually a fee for the doctor to complete this form, which you pay out of pocket.

Processing typically takes several weeks. If approved, you will receive a chronic pediatric disease medical care recipient certificate (shounikaman tokuteishippei iryou jukyuusha shou / 小児慢性特定疾病医療受給者証). The reduced copay applies from the date the application was accepted, so even if the recipient certificate takes time to arrive, you are covered from that date. You may need to pay the full amount initially and apply for reimbursement for the period before the recipient certificate arrives.

Designated Medical Institutions

The reduced copay only applies at medical institutions that are designated for this program (shitei shounikaman tokuteishippei iryou kikan / 指定小児慢性特定疾病医療機関). This includes hospitals, clinics, pharmacies, and visiting nurse services. Most major hospitals are designated, but confirm before your first visit. If you need to change institutions, apply for a change through your prefectural health center. In emergencies, you can use a non-designated institution and apply for reimbursement afterward.

Renewal

The recipient certificate is valid for one year. You must renew annually by submitting an updated application before the expiration date. The medical opinion form is required with each renewal. Start the renewal process early, as processing takes time and a gap in coverage means you pay the full copay during that period.

The Age 18 Rule

This is one of the most important things to understand about this program.

If your child is certified when they turn 18 and still needs treatment, coverage can be extended until age 20. You must renew before the recipient certificate expires.

If the certification lapses after age 18, your child cannot reapply. The door closes permanently. This means if you miss a renewal after your child turns 18, they lose access to this program.

If your child’s condition continues into adulthood, look into the intractable disease medical care recipient certificate (tokutei iryouhi jukyuusha shou / 特定医療費受給者証), which is the adult equivalent for designated intractable diseases. Not all pediatric chronic diseases have a corresponding adult designation, so check whether your child’s condition is covered. This is especially important for families planning for adulthood. See our article on the transition to adulthood for more context.

How This Relates to Other Medical Cost Programs

Your child may be eligible for multiple medical cost reduction programs. Each one works differently:

The chronic pediatric disease recipient certificate (this article) reduces the copay for the designated disease to an income-based monthly cap at designated institutions.

The independence support medical care recipient certificate (jiritsu shien iryou jukyuusha shou / 自立支援医療受給者証) reduces costs for specific ongoing treatments. See our article on the jiritsu shien iryou jukyuusha shou.

The severely disabled persons medical fee subsidy (juudo shinshin shougaisha iryouhi josei seido / 重度心身障害者医療費助成制度) covers remaining out-of-pocket costs for people with severe disabilities. See our article on the severely disabled persons medical fee subsidy.

When presenting at a medical institution, show all of your recipient certificates. The chronic pediatric disease recipient certificate takes priority, and the other programs may cover any remaining costs.

Practical Tips

Ask your child’s specialist doctor whether your child’s condition is on the designated disease list. Many families of children with disabilities do not think to ask because they see their child’s condition as a disability, not a disease. But if the underlying condition is on the list, the cost reduction applies regardless of whether your child also holds a disability handbook.

Do not let the recipient certificate lapse after age 18. Set calendar reminders well in advance of each renewal.

Keep the medical opinion form fee in mind when budgeting. This is an out-of-pocket cost each year for renewal.

If your child also qualifies for the severely disabled persons medical fee subsidy, use both. The chronic pediatric disease recipient certificate is applied first, and the medical fee subsidy can cover the remaining copay.

The application goes to your prefectural health center (hokenjo / 保健所), not to the disability welfare desk (shougai fukushi ka / 障害福祉課) at the ward office. These are different offices.

Key Terms

English	Japanese
Chronic pediatric disease medical fee subsidy	shounikaman tokuteishippei iryouhi josei seido / 小児慢性特定疾病医療費助成制度
Chronic pediatric disease medical care recipient certificate	shounikaman tokuteishippei iryou jukyuusha shou / 小児慢性特定疾病医療受給者証
Designated chronic pediatric disease	shounikaman tokuteishippei / 小児慢性特定疾病
Designated medical institution	shitei shounikaman tokuteishippei iryou kikan / 指定小児慢性特定疾病医療機関
Designated doctor	shitei i / 指定医
Medical opinion form	iryou ikensho / 医療意見書
Prefectural health center	hokenjo / 保健所
Copay cap tracking sheet	jiko futan jougen gaku kanri hyou / 自己負担上限額管理票