Disability Welfare Services in Japan: A Useful Guide by Life Stage
When your child is first diagnosed with a disability, one of the hardest things is figuring out what support is actually available and how to get it. Many families struggle with this. Japan has a wide range of disability welfare services, but they require different recipient certificates and change as your child grows. It can feel overwhelming.
This article is a starter map. It covers the disability welfare services available in Japan, organized by the stage of life where they become relevant: the early years, the school years, and adulthood.
The Recipient Certificates
Before looking at the services themselves, it helps to understand that Japan uses several separate recipient certificates, and each one covers a different set of services. There are two important things to know upfront: you may need more than one recipient certificate, and you do not necessarily need a disability handbook (techou / 手帳, also called a disability certificate) to apply for any of them.
When you are approved for a service, you receive a paper document called a recipient certificate (jukyuusha shou / 受給者証). This is usually an A4-sized sheet of paper. You bring it to the service provider every time you use the service. It tells the provider your recipient number (jukyuusha shou bangou / 受給者証番号), what services you are approved for, how many hours or days per month you can use (shikyuuryou tou / 支給量等), and your monthly copay cap (futan jougen getsugaku / 負担上限月額). The provider enters your number into their system, and the government covers its share. You pay only the copay listed on the document, or nothing at all if your cap is zero. The word jukyuusha shou is sometimes translated as ‘beneficiary certificate’; on this site, we call them recipient certificates.
Service-access certificates
Day services recipient certificate (tsuusho jukyuusha shou / 通所受給者証):
Covers day services for children: therapy, after-school programs, school visit support, and home-visit developmental support. Nationwide, same rules everywhere. Applied for at the municipal welfare desk. See our standalone article on the tsuusho jukyuusha shou.
Children’s institutional care recipient certificate (nyuusho jukyuusha shou / 入所受給者証):
For children under 18 who need residential care at a disability child residential facility. Applied for through the child guidance center (jidou soudanjo / 児童相談所), not the welfare desk. Nationwide. See our standalone article on the nyuusho jukyuusha shou.
Covers a broad range of services for both children and adults: home help, respite care, behavioral support, employment programs, group homes, day activity centers, and more. Nationwide, same rules everywhere. Applied for at the municipal welfare desk. See our standalone article on the shougai fukushi saabisu jukyuusha shou.
Covers municipal services including mobility support and daytime temporary care. The program exists nationwide, but each municipality decides which services to offer, how many hours to approve, and what to charge. What you get depends on where you live. Applied for at the municipal welfare desk. See our standalone article on the chiiki seikatsu shien jigyou jukyuusha shou.
Consultation support recipient certificates (chiiki soudan shien jukyuusha shou / 地域相談支援受給者証 and keikaku soudan shien / 計画相談支援):
Cover professional support for transitioning from a facility to community living and for creating and monitoring your service use plan. Both are free. Nationwide. See our standalone article on consultation support recipient certificates.
Medical-cost certificates
Reduces medical costs for children under 18 with one of the designated chronic childhood diseases. Many children with disabilities also have a qualifying chronic condition. Nationwide, same rules everywhere. Applied for at the prefectural health center (hokenjo / 保健所), not the ward office. See our standalone article on this certificate.
Reduces the cost of ongoing medical care related to a disability. Covers three subtypes: psychiatric outpatient care, physical disability treatment for adults, and medical treatment for children with disabilities. Nationwide, same rules everywhere. See our standalone article on the jiritsu shien iryou jukyuusha shou.
Intractable disease medical care recipient certificate (tokutei iryouhi jukyuusha shou / 特定医療費受給者証):
Reduces medical costs for people with one of the designated intractable diseases. People with intractable diseases can also access disability welfare services without a disability handbook. Nationwide, same rules everywhere. Applied for at the prefectural health center (hokenjo / 保健所). See our standalone article on the tokutei iryouhi jukyuusha shou.
Most recipient certificates applied for at the municipal welfare desk are processed at the same office: the disability welfare desk (shougai fukushi tantou madoguchi / 障害福祉担当窓口) at your city or ward office. The chronic pediatric disease and intractable disease certificates are applied for at the prefectural health center (hokenjo / 保健所), a different office. The children’s institutional care certificate is applied for through the child guidance center (jidou soudanjo / 児童相談所).
Quick Reference:
| Service | Recipient Certificate Needed |
| Child development support / therapy, 0-6 (jidou hattatsu shien / 児童発達支援) | Day services recipient certificate (tsuusho jukyuusha shou / 通所受給者証) |
| After-school day service, 6-18 (houkago tou dei saabisu / 放課後等デイサービス) | Day services recipient certificate (tsuusho jukyuusha shou / 通所受給者証) |
| School/nursery visit support (hoikusho tou houmon shien / 保育所等訪問支援) | Day services recipient certificate (tsuusho jukyuusha shou / 通所受給者証) |
| Home-visit child development support (kyotaku houmon gata jidou hattatsu shien / 居宅訪問型児童発達支援) | Day services recipient certificate (tsuusho jukyuusha shou / 通所受給者証) |
| Home help (kyotaku kaigo / 居宅介護) | Disability welfare services recipient certificate (shougai fukushi saabisu jukyuusha shou / 障害福祉サービス受給者証) |
| Short stay / respite (tanki nyuusho / 短期入所) | Disability welfare services recipient certificate |
| Behavioral support (koudou engo / 行動援護) | Disability welfare services recipient certificate |
| Day program, 18+ (seikatsu kaigo / 生活介護) | Disability welfare services recipient certificate |
| Employment transition, 18+ (shuurou ikou shien / 就労移行支援) | Disability welfare services recipient certificate |
| Continued employment A/B, 18+ (shuurou keizoku shien / 就労継続支援A型・B型) | Disability welfare services recipient certificate |
| Independent living training, 18+ (jiritsu kunren / 自立訓練) | Disability welfare services recipient certificate |
| Group home, 18+ (kyoudou seikatsu enjo / 共同生活援助) | Disability welfare services recipient certificate |
| Intensive home visit care (juudo houmon kaigo / 重度訪問介護) | Disability welfare services recipient certificate |
| Facility residential support (shisetsu nyuusho shien / 施設入所支援) | Disability welfare services recipient certificate |
| Medical long-term care (ryouyou kaigo / 療養介護) | Disability welfare services recipient certificate |
| Children’s residential care (shougaiji nyuusho shisetsu / 障害児入所施設) | Children’s institutional care recipient certificate (nyuusho jukyuusha shou / 入所受給者証) |
| Mobility support (idou shien / 移動支援) | Community life support program recipient certificate (chiiki seikatsu shien jigyou jukyuusha shou / 地域生活支援事業受給者証) |
| Daytime temporary care (nichijuu ichiji shien / 日中一時支援) | Community life support program recipient certificate |
| Service use plan creation (keikaku soudan shien / 計画相談支援) | Arranged through a consultation support provider (planning service) |
| Transition to community living (chiiki ikou shien / 地域移行支援) | Community consultation support recipient certificate (chiiki soudan shien jukyuusha shou / 地域相談支援受給者証) |
| Medical cost reduction (jiritsu shien iryou / 自立支援医療) | Independence support medical care recipient certificate (jiritsu shien iryou jukyuusha shou / 自立支援医療受給者証) |
| Severely disabled medical fee subsidy (重度心身障害者医療費助成) | Severely disabled medical fee subsidy program, usually a medical certificate (医療証) |
| Chronic pediatric disease (小児慢性特定疾病) | Chronic pediatric disease medical care recipient certificate |
| Intractable disease (指定難病) | Intractable disease medical care recipient certificate |
Part 1: The Early Years (Birth to School Age, Approximately 0 to 6)
The early years are when most families first enter the disability support system. After a diagnosis or a professional recommendation that your child needs developmental support, these are the services available.
Child Development Support (Jidou Hattatsu Shien / 児童発達支援)
Recipient certificate needed: Day services recipient certificate (tsuusho jukyuusha shou / 通所受給者証)
This is the main therapy and developmental support service for preschool-age children. Your child attends a facility (sometimes called jihatsu / 児発 for short) where they receive structured developmental support in a small group or one-on-one setting. Sessions may include speech therapy, occupational therapy, physical therapy, social skills activities, sensory play, and structured learning. Some children attend jihatsu as their primary daytime activity (full-day programs), while others attend part-time alongside regular preschool or kindergarten. The number of days per month your child can attend is set on your tsuusho jukyuusha shou (通所受給者証).
Note: As of April 2024, the revised Child Welfare Act merged the former medical-type child development support (iryougata jidou hattatsu shien / 医療型児童発達支援) into regular child development support, so it is no longer a separate service category. Children who need treatment alongside developmental support can still receive it within 児童発達支援 at facilities equipped to provide it.
Home-Visit Child Development Support (Kyotaku Houmon Gata Jidou Hattatsu Shien / 居宅訪問型児童発達支援)
Recipient certificate needed: Day services recipient certificate (tsuusho jukyuusha shou / 通所受給者証)
For children who cannot attend a facility due to severe disability or medical fragility. A therapist or developmental specialist visits your child at home and provides one-on-one developmental support.
Home Help (Kyotaku Kaigo / 居宅介護)
Recipient certificate needed: Disability welfare services recipient certificate (shougai fukushi saabisu jukyuusha shou / 障害福祉サービス受給者証)
A trained home helper comes to your house to assist with your child’s daily care: bathing, dressing, meals, toileting, and housework. Even a few hours a week of home help can make an enormous difference when you are caring for a young child with significant support needs. This service is available from birth onward.
Short Stay / Respite (Tanki Nyuusho / 短期入所)
Recipient certificate needed: Disability welfare services recipient certificate (shougai fukushi saabisu jukyuusha shou / 障害福祉サービス受給者証)
Your child stays overnight at a care facility for a short period while trained staff take care of them. This gives you, as a parent, time to rest, take care of your own health, handle an emergency, or simply recharge. See our article on respite care and home help for more detail.
Medical Cost Reduction (Jiritsu Shien Iryou / 自立支援医療)
Recipient certificate needed: Independence support medical care recipient certificate (jiritsu shien iryou jukyuusha shou / 自立支援医療受給者証)
If your child sees a psychiatrist, developmental specialist, or other doctor on an ongoing outpatient basis for a disability-related condition, this program reduces your out-of-pocket costs, with an income-based monthly cap. See the standalone article on this site for full details.
If your child also qualifies for 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) or the chronic pediatric disease medical care recipient certificate (shouni mansei tokutei shippei iryou jukyuusha shou / 小児慢性特定疾病医療受給者証), those programs can reduce costs further. See our standalone articles on each.
Part 2: The School Years (Age 6 to 18)
When your child enters elementary school, the available services shift. Jihatsu ends and is replaced by after-school programs. Home help, respite, and medical cost reduction continue. New services become available.
After-School Day Service (Houkago Tou Dei Saabisu / 放課後等デイサービス)
Recipient certificate needed: Day services recipient certificate (tsuusho jukyuusha shou / 通所受給者証)
This is the main service for school-age children. Your child attends a facility after school, on Saturdays, and during school holidays. Activities typically include social skills training, homework support, physical activities, arts and crafts, cooking and life skills practice, and outings. Many families think of houday (放デイ, the common abbreviation) as a combination of after-school care and ongoing therapy. Your child can attend more than one houday facility, as long as the total days do not exceed the number approved on their tsuusho jukyuusha shou (通所受給者証).
School and Nursery Visit Support (Hoikusho Tou Houmon Shien / 保育所等訪問支援)
Recipient certificate needed: Day services recipient certificate (tsuusho jukyuusha shou / 通所受給者証)
A specialist visits your child’s school, nursery, or kindergarten to provide support in their regular educational setting.
Home Help (Kyotaku Kaigo / 居宅介護)
Recipient certificate needed: Disability welfare services recipient certificate
The same home help service from the early years continues throughout the school years.
Short Stay / Respite (Tanki Nyuusho / 短期入所)
Recipient certificate needed: Disability welfare services recipient certificate
Respite care continues to be available and, for many families, becomes even more important as children get older and physically larger. See our article on respite care and home help for more detail.
Mobility Support (Idou Shien / 移動支援)
Recipient certificate needed: Community life support program recipient certificate (chiiki seikatsu shien jigyou jukyuusha shou / 地域生活支援事業受給者証)
A helper accompanies your child when going out for social activities, community events, shopping, or leisure. This is a municipal program, so availability and specific rules vary by area. See our article on the community life support program recipient certificate for details.
Daytime Temporary Care (Nichijuu Ichiji Shien / 日中一時支援)
Recipient certificate needed: Community life support program recipient certificate
Your child is cared for during the day at a registered facility while you rest or handle personal matters. This is daytime only, with no overnight stay. It is different from after-school day services, which focus on structured therapy and skill-building. Daytime temporary care is specifically about giving the caregiver a break. Not every municipality offers this service. See our article on respite care and home help for more detail.
Behavioral Support (Koudou Engo / 行動援護)
Recipient certificate needed: Disability welfare services recipient certificate
For children with intellectual or mental health disabilities whose decision-making abilities are limited and who need safety support when going outside.
Medical Cost Reduction (Jiritsu Shien Iryou / 自立支援医療)
Recipient certificate needed: Independence support medical care recipient certificate (jiritsu shien iryou jukyuusha shou / 自立支援医療受給者証)
The medical cost reduction program continues throughout the school years and into adulthood. It must be renewed annually.
Part 3: Adulthood (Age 18 and Beyond)
When your child turns 18, the Child Welfare Act (jidou fukushi hou / 児童福祉法) services end. Jihatsu and houday stop. The tsuusho jukyuusha shou (通所受給者証) is no longer used. From this point on, the main recipient certificate is the disability welfare services recipient certificate (shougai fukushi saabisu jukyuusha shou / 障害福祉サービス受給者証), along with the community life support program recipient certificate for municipal services. The range of services expands significantly in adulthood. Start visiting adult service providers and talking to the welfare desk about the transition well before your child’s 18th birthday. For detailed guidance on the transition itself, see the “When Your Child Turns 18” article on this site.
Day Program (Seikatsu Kaigo / 生活介護)
Recipient certificate needed: Disability welfare services recipient certificate
Needs assessment required: Yes (shougai shien kubun / 障害支援区分, classification 3 or higher)
Daytime programs at a facility where the person receives personal care and participates in creative activities, physical activities, and social interaction. This is the main daytime option for adults with disabilities who do not work or who need more support than an employment program can provide.
Employment Support Services
Recipient certificate needed: Disability welfare services recipient certificate
Needs assessment required: No
Japan has a structured system of employment support.
Employment transition support (shuurou ikou shien / 就労移行支援) is a time-limited program (up to 24 months).
Continued employment A (shuurou keizoku shien A gata / 就労継続支援A型) provides employment under a contract.
Continued employment B (shuurou keizoku shien B gata / 就労継続支援B型) provides productive activities with a production-based allowance.
Employment choice support (shuurou sentaku shien / 就労選択支援), which began in October 2025, helps people explore employment pathways through assessment and work trials.
Independent Living Training (Jiritsu Kunren / 自立訓練)
Recipient certificate needed: Disability welfare services recipient certificate
Needs assessment required: No
Training in daily living skills. Time-limited (generally up to about two years). Two types: functional/physical rehabilitation (kinou kunren / 機能訓練) and life skills training (seikatsu kunren / 生活訓練).
Group Home (Kyoudou Seikatsu Enjo / 共同生活援助)
Recipient certificate needed: Disability welfare services recipient certificate
Needs assessment required: No
Small, community-based shared living arrangements with staff support. See the “Group Homes in Japan” article on this site for full details.
Home Help (Kyotaku Kaigo / 居宅介護)
Recipient certificate needed: Disability welfare services recipient certificate
Needs assessment required: Yes (classification 1 or higher)
Home help continues into adulthood.
Intensive Home Visit Care (Juudo Houmon Kaigo / 重度訪問介護)
Recipient certificate needed: Disability welfare services recipient certificate
Needs assessment required: Yes (classification 4 or higher)
For people with severe disabilities who need extended, comprehensive support at home, including overnight care and assistance during hospital stays.
Short Stay / Respite (Tanki Nyuusho / 短期入所)
Recipient certificate needed: Disability welfare services recipient certificate
Needs assessment required: Yes (classification 1 or higher)
Respite care continues into adulthood.
Facility Residential Support (Shisetsu Nyuusho Shien / 施設入所支援)
Recipient certificate needed: Disability welfare services recipient certificate
Needs assessment required: Yes (classification 4 or higher, or 3 with specific conditions)
For people who live in a disability support facility and receive nighttime care and daily living support.
Medical Long-Term Care (Ryouyou Kaigo / 療養介護)
Recipient certificate needed: Disability welfare services recipient certificate
Needs assessment required: Yes (classification 5 or higher with specific medical needs)
For people who need both ongoing medical treatment and daily care, provided in a medical facility.
Mobility Support (Idou Shien / 移動支援)
Recipient certificate needed: Community life support program recipient certificate
Mobility support continues into adulthood, helping the person participate in community life, social activities, and leisure.
Behavioral Support (Koudou Engo / 行動援護)
Recipient certificate needed: Disability welfare services recipient certificate
Needs assessment required: Yes (classification 3 or higher)
Safety and communication support when going outside.
Medical Cost Reduction (Jiritsu Shien Iryou / 自立支援医療),
Recipient certificate needed: Independence support medical care recipient certificate (jiritsu shien iryou jukyuusha shou / 自立支援医療受給者証)
The medical cost reduction program continues throughout adulthood. For adults, kousei iryou (更生医療 / medical care for adults with physical disabilities) may also become relevant if the person holds a physical disability handbook (shintai shougaisha techou / 身体障害者手帳). If the person has an intractable disease, the intractable disease medical care recipient certificate (tokutei iryouhi jukyuusha shou / 特定医療費受給者証) may also apply. See our standalone articles on each.
Note: When a person with a disability turns 65, the long-term care insurance system (kaigo hoken seido / 介護保険制度) takes priority over the disability welfare system for services that overlap. Some disability-specific services continue, but others shift to the elderly care system. See our article on the long-term care insurance certificate for details.
Part 4: Consultation Support (Available at Every Stage)
Throughout all of these life stages, there is a system of consultation support (soudan shien / 相談支援) designed to help families and individuals navigate the services above.
Service planning support (keikaku soudan shien / 計画相談支援): A consultation support specialist creates and reviews the person’s service use plan, coordinating their different services. This is the planning service behind your recipient certificate application; it is arranged through a consultation support provider, is free, and is available at any stage.
- Community transition support (chiiki ikou shien / 地域移行支援): Helps people move from a facility or hospital into community living
- Community settlement support (chiiki teichaku shien / 地域定着支援): Provides ongoing emergency support and consultation for people who live alone or with family.
Community transition support and community settlement support are covered by the community consultation support recipient certificate (chiiki soudan shien jukyuusha shou / 地域相談支援受給者証). Service planning support does not require a separate carried certificate; it is the planning service that produces your service use plan. All are free. See our article on consultation support recipient certificates for details.
See the “Consultation and Support Centers for Families” article on this site for full details.
How Service Costs Work
All disability welfare services in Japan use the same basic cost structure: the government covers most of the cost, and the family or individual pays a copay with an income-based monthly cap. For most families, the monthly cap is very low or zero.
One important change at age 18: for adults, the household for income purposes is only the person with the disability and their spouse. Parents are no longer counted. This means that most adults with disabilities who do not have significant personal income pay nothing for services.
For current cost tiers and caps, check with your welfare desk or see the MHLW page linked below.
Practical Tips
- You may need more than one recipient certificate. Many families with young children have a day services recipient certificate for therapy and houday, a disability welfare services recipient certificate for home help or respite, and a community life support program recipient certificate for mobility support. Ask about all of them when you visit the welfare desk.
- You do not need a disability handbook to access services. A doctor’s opinion letter or professional recommendation is enough to apply for the recipient certificates. Do not wait for a handbook if your child needs support now.
- Start with the welfare desk. They are the single point of entry for most of these services and recipient certificates. For the chronic pediatric disease and intractable disease medical care recipient certificates, go to the prefectural health center (hokenjo / 保健所) instead.
- Visit providers before choosing. Every facility has its own culture, approach, and quality. Visit at least two or three before deciding.
- Use the WAMNET provider search. This government-affiliated directory lets you search for service providers by area and service type.
- Think about respite early. Short stay is not just for emergencies. Using it regularly helps prevent burnout and helps your child practice being away from home.
- Plan the transition to adult services early. Start visiting adult service providers and talking to the welfare desk at least a year before your child turns 18.
- Check for other medical cost reduction programs. Beyond the jiritsu shien iryou, the severely disabled persons medical fee subsidy, the chronic pediatric disease recipient certificate, and the intractable disease recipient certificate can each reduce medical costs significantly. See our standalone articles on each.
- Services can be combined. A person might attend a day program during the day, live in a group home, use home help on weekends, and have short stay once a month. The service use plan coordinates everything.
Key Terms
| English | Japanese |
| Day services recipient certificate | tsuusho jukyuusha shou / 通所受給者証 |
| Disability welfare services recipient certificate | shougai fukushi saabisu jukyuusha shou / 障害福祉サービス受給者証 |
| Community life support program recipient certificate | chiiki seikatsu shien jigyou jukyuusha shou / 地域生活支援事業受給者証 |
| Children’s institutional care recipient certificate | nyuusho jukyuusha shou / 入所受給者証 |
| Independence support medical care recipient certificate | jiritsu shien iryou jukyuusha shou / 自立支援医療受給者証 |
| Severely disabled medical fee subsidy (program) | juudo shinshin shougaisha iryouhi josei seido / 重度心身障害者医療費助成制度 |
| Chronic pediatric disease medical care recipient certificate | shouni mansei tokutei shippei iryou jukyuusha shou / 小児慢性特定疾病医療受給者証 |
| Intractable disease medical care recipient certificate | tokutei iryouhi jukyuusha shou / 特定医療費受給者証 |
| Community consultation support recipient certificate | chiiki soudan shien jukyuusha shou / 地域相談支援受給者証 |
| Service planning support | keikaku soudan shien / 計画相談支援 |
| Long-term care insurance certificate | kaigo hoken hihokensha shou / 介護保険被保険者証 |
| Disability support classification (grades 1-6) | shougai shien kubun / 障害支援区分 |
| Care benefits (require needs assessment) | kaigo kyuufu / 介護給付 |
| Training benefits (no assessment required) | kunren tou kyuufu / 訓練等給付 |
| Community life support programs (municipal) | chiiki seikatsu shien jigyou / 地域生活支援事業 |
| Consultation support | soudan shien / 相談支援 |
| Disability welfare desk | shougai fukushi tantou madoguchi / 障害福祉担当窓口 |
| Prefectural health center | hokenjo / 保健所 |
Useful Resources
- MHLW: Disability Welfare Services Overview (障害福祉サービスについて) — https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hukushi_kaigo/shougaishahukushi/service/index_00001.html
- MHLW: Service Types and Eligibility (サービスの内容) — https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hukushi_kaigo/shougaishahukushi/service/naiyou.html
- MHLW: Disability Children’s Services (障害児支援施策) — https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000117218.html
- MHLW: Community Life Support Program (地域生活支援事業について) — https://www.mhlw.go.jp/bunya/shougaihoken/chiiki/gaiyo.html
- MHLW: Service Application Procedures (利用の手続き) — https://www.mhlw.go.jp/bunya/shougaihoken/service/riyou.html
- MHLW: User Fees for Disability Services (利用者負担) — https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hukushi_kaigo/shougaishahukushi/service/hutan1.html
- MHLW: User Fees for Children’s Services (障害児の利用者負担) — https://www.mhlw.go.jp/bunya/shougaihoken/service/hutan2.html
- MHLW: Disability Support Classification (障害支援区分) — https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hukushi_kaigo/shougaishahukushi/kubun/index.html
- WAMNET: Service Provider Search (障害福祉サービス等情報検索) — https://www.wam.go.jp/
