The Medical Care Child Support Act has been revised, and it will come into effect on April 1, 2027. The revised law was promulgated on July 31, 2026.
The most significant change is that the support will extend to individuals aged 18 and older, as well as those with severe physical and mental disabilities. This law directly addresses the long-standing issue referred to as the "18-year-old wall."
However, there is still time before the law is implemented.
In this article, we will first clarify what the Medical Care Child Support Act is, then explain what changes will occur starting in April 2027, and finally discuss the challenges that will remain after implementation. This information will be useful for children requiring medical care, their families, and those involved in providing support.
1.What is the Medical Care Child Support Act? Changes in Eligibility Starting April 2027
1-1.Current Official Name and New Title After Revision
The current official name of the law is "The Act on Support for Medical Care Children and Their Families" (Act No. 81 of 2021). After April 1, 2027, the title will change to "The Act on Support for Medical Care Children, Severe Physical and Mental Disabilities, and Their Families." It is often referred to simply as the "Medical Care Child Support Act" in newspapers and websites.
What kind of law is it? The first article provides clarity.
This law is established in light of the increasing number of medical care children due to advancements in medical technology, the diversification of their circumstances, and the importance of ensuring that medical care children and their families receive appropriate support tailored to the individual medical care child's physical and mental conditions. It aims to establish basic principles regarding support for medical care children and their families, clarify the responsibilities of the national and local governments, and set forth necessary measures, including the expansion of childcare and education, and the designation of medical care child support centers, thereby contributing to the healthy growth of medical care children and preventing their families from leaving the workforce, ultimately fostering a society where families can safely give birth and raise children.
引用元：The Act on Support for Medical Care Children and Their Families (Act No. 81 of 2021) | Ministry of Health, Labour and Welfare
This lengthy sentence spans multiple lines, but when broken down, it becomes clearer what the law aims to achieve, the means to accomplish it, and the background of its establishment.
1-1-1. Purpose: What Do We Want to Achieve?
- Promote the healthy growth of medical care children and prevent their families from leaving the workforce.
- Realize a society where families can safely give birth and raise children.
Support for not only the growth of medical care children but also their families is mentioned. The inclusion of language in the law aimed at "increasing the options for families' ways of living" is considered a significant value.
1-1-2. Means: How Will We Achieve This?
- Clarify the responsibilities of the national and local governments regarding support for medical care children and their families.
- Establish measures related to the expansion of childcare and education, other necessary measures, and the designation of medical care child support centers by law.
Support for medical care children is regarded as the "responsibility" of the national and local governments. This law creates a situation where municipalities are compelled to engage in support efforts.
Moreover, a concrete change resulting from this law is the establishment of "medical care child support centers." This will be discussed later in '2. What Changes Will Occur Due to the Medical Care Child Support Act?'
1-1-3. Background: Why Was the Law Created?
“With the increase in medical care children due to advancements in medical technology and the diversification of their circumstances, ensuring that medical care children and their families receive appropriate support tailored to the individual medical care child's physical and mental conditions is a significant challenge.”
The increase in medical care children and the accompanying diversification of their lives is somewhat vague, so let’s delve deeper into this.
1-2. Why Was the Medical Care Child Support Act Established?
As of 2025, it is estimated that there will be 21,496 medical care children (ages 0-19) living at home. This is a significant increase from 9,987 in 2005, effectively doubling over the past 20 years.
The most notable change is in the number of children using ventilators, which has risen from 264 in 2005 to 6,521 in 2025. Not only has the number of medical care children increased, but more children requiring severe care are now living at home, highlighting the urgent need for improved support systems.
参照：医療的ケア児の現状について｜医療的ケア児等とその家族に対する支援施策｜こども家庭庁
Children who require medical care, such as those who had to undergo surgeries like tracheostomy or need feeding tubes because they cannot take nutrition orally, face various difficulties the moment they are discharged from the hospital.
First is the fatigue. Parents may experience chronic sleep deprivation due to the need for 24-hour care for their child, leading to physical and mental exhaustion.
Then comes the feelings of loneliness and isolation. Even when physically exhausted, there are few places to turn for help, and some must shoulder the care responsibilities alone. Some feel socially isolated due to the lack of childcare options for medical care children, forcing them to leave their jobs.
This loss of employment also creates financial anxiety.
Despite having saved a life, the lack of societal support forces families to bear the burden alone, prompting the establishment of the Medical Care Child Support Act to create a system of support from the entire society.
2.【Effective April 1, 2027】What Changes Will Occur with the Revision of the Medical Care Child Support Act, and When?
The revised law was promulgated on July 31, 2026, and it will come into effect on April 1, 2027. Therefore, at the time of this article's publication, the current law is still in effect, and the changes will actually take effect starting in April 2027.
Change 1 | The eligibility for support will expand to include "those aged 18 and older" and "individuals with severe physical and mental disabilities."
Overview of the Law (Amended Law) | Support Measures for Children with Medical Care Needs and Their Families | Children's and Families Agency
The current law, which came into effect in 2021, has already initiated some changes.
1. Expansion of childcare systems
2. Expansion of educational systems
3. Support in daily life
4. Development of consultation systems
5. Promotion of information sharing
These are the five items.It has been very difficult for children with medical care needs to attend daycare or school alone. This is because only qualified personnel such as nurses and certified care workers can provide the necessary medical care on a daily basis.
In fact, when consulting at administrative offices, there are cases where parents are turned away with reasons such as "there are no facilities that can accept them" or "we cannot secure staff."
As a result, it is not uncommon for parents to have no choice but to care for their children at home or accompany them to daycare or school.
To improve such situations, the Medical Care Needs Support Law states that an environment must be created where necessary personnel are assigned to provide childcare and education (corresponding to the above items 1 and 2).
By improving the childcare and educational environment for children, it is expected to contribute to one of the objectives of this law, which is to "prevent parents from leaving their jobs."
Additionally, the establishment of medical care support centers for children with medical care needs, which provide a one-stop consultation service for support related to these children, is also a significant change (corresponding to the above item 4).
Previously, even if there were issues or necessary support, parents had to directly contact each relevant organization such as hospitals, government offices, facilities, and businesses.
Since not everyone in the relevant organizations is knowledgeable about children with medical care needs, there have been times when parents were passed around or had to explain the same thing multiple times, making it difficult to access the necessary support.
The medical care support center is expected to improve this situation.
When receiving consultations from parents, the center will provide comprehensive support, including contacting relevant organizations as needed, bridging communication with parents, and training for facilities.
By legally defining the support content in this way, the establishment of an environment for children with medical care needs has become a legal "responsibility" rather than just an effort, and it is expected that various facilities and administrative organizations will actively work on improving the environment.
3. Remaining Concerns After the Amended Law
In the amendment in April 2027, support after turning 18 years old became legally recognized. However, expanding the law's coverage and actually establishing local support systems are two separate issues.
The percentage of facilities capable of providing medical care in daily living support and the duration of care will depend on the efforts of each municipality after implementation.
3-1. The 18-Year Barrier: Even with Legal Changes, Support Systems Are Yet to Be Established
Before the amendment, the target of the Medical Care Needs Support Law was, in principle, under 18 years old (including high school students).
Upon graduating from special support high schools, individuals become "medical care recipients," and the welfare services available to them change significantly..
This transition is referred to as the "18-Year Barrier."
While in school, "school" and "after-school day services" serve as two daytime locations, allowing parents to continue working during that time.
However, after graduation, after-school day services are generally no longer available, and daytime activities switch to "living care" or "intensive home care."
Only about 20% of living care facilities can accommodate medical care, and as a result of losing their daytime locations, it is not uncommon for parents to be forced to leave their jobs again.
Additionally, the "shortening" of care hours is a significant barrier.
Until high school graduation, support was available through after-school day services until the evening, but many adult living care facilities close around 3 to 4 PM, leading to persistent complaints that "after turning 18, parents are forced to change to part-time work or leave their jobs."
There are also barriers in medical care.
While in school, patients are treated at pediatric specialty hospitals, but after turning 18, they must find new hospitals on their own, and there have been reports of individuals being turned away from multiple hospitals due to complex medical conditions.
In response to this issue, the city of Kyoto is consolidating four welfare facilities for children and adults into one location called "Rakuwa Care Center Totonou" (scheduled to open in 2025), while Shinagawa Ward has started a subsidy program for operators extending living care hours, indicating that innovative initiatives are beginning to spread.
The law's supplementary provisions state "consideration within three years of implementation," raising expectations for future system revisions.
3-2. Disaster Preparedness: Securing Power Sources and Individual Evacuation Plans
For children with medical care needs who rely on power for devices like ventilators and suction machines, power outages during disasters are a life-threatening issue.
The amendment to the Disaster Countermeasures Basic Act in 2021 made it a municipal obligation to create individual evacuation plans for those requiring assistance during evacuation.
This plan determines "when, where, and with whose support to evacuate" in advance, butin some areas, children with medical care needs are not clearly designated as individuals requiring consideration in disaster plans, and many cases remain unaddressed.
For power outage measures, it is recommended to consider securing power sources in the following order:
Internal batteries (those built into medical devices)
External batteries (such as portable power sources)
Power supply from the car's cigarette lighter
Generators (for outdoor use)
However, the financial burden of equipping oneself adequately is significant, so it is also important to check whether the municipality has an emergency power supply loan program.
Additionally, registering with the "MEIS (Medical Information Sharing System for Children with Medical Care Needs)" operated by the Children's and Families Agency is also a way to prepare for disasters.
By pre-registering information such as regular medications, care details, and primary doctor information, medical institutions receiving patients during disasters or emergency transport can access patient information.
Registration is free, but only about 406 individuals are registered, which is still very few compared to approximately 20,000 children with medical care needs nationwide.
First, consult your primary doctor about wanting to register for MEIS.
Miyagi Prefecture
The revised law has established provisions regarding the review of the methods of providing medical care by the national and local governments. However, the extent to which this will expand will depend on future discussions. 6. Conclusion
Support for children requiring medical care is the responsibility of local governments, aiming to realize a society where "families can prevent job loss" and "children can be born and raised with peace of mind."
The update of this law may be a welcome development for children requiring medical care and their families.
However, it is important to note that the situation will not improve immediately, so it is essential to continue monitoring even after the revision.
In fact, I am also raising a preschool-aged child who requires medical care, and over the past few months, I have been busy searching for a nursery and securing support after enrollment. It required a lot of time and effort, as I had to engage in discussions with the local government.
I have personally felt that the environment is still not fully established. However, amidst this, I have also recognized the value of medical care support centers and the encouragement from supporters who negotiate confidently, saying, "Now that the support law has been established."
The frustration of "even though the law has been enacted, things are still not in place" and the appreciation of "things are slightly improving because the law has been enacted."
Perhaps we are currently in a middle ground where both exist.
To ensure that all children requiring medical care and their families can achieve the lives they desire, I hope to look forward to and monitor future changes.
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