Response to interpellation 2024/25:309 on parents seeking additional cost compensation
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns the regulatory framework and the assessment criteria for additional cost compensation for children with disabilities. M argues that the 2019 reform aimed for increased clarity and legal certainty 1. M emphasizes that the high rejection rate is due to the design of the benefit, not Försäkringskassan's application 2. M wants to wait for an in-depth evaluation from ISF before changes are made to ensure well-founded proposals 3 4. S argues that the system is difficult to access, bureaucratic, and that parents are met with a wall of information 5 6. S believes that the reform needs to be reviewed and requests concrete measures in the short term to facilitate things for families 5. S also wants faster improvements to the information on Försäkringskassan's website 7.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Statsrådet Camilla Waltersson Grönvall (M)
Mr. Speaker! Jessica Rodén has asked the Minister for Pensions and Social Insurance whether she considers the regulatory framework and the assessment criteria for the extra cost allowance to be legally secure and sufficiently adapted to meet the needs of children with disabilities and their families. She has also asked the Minister for Pensions and Social Insurance what measures she intends to take to ensure that the extra cost allowance reaches the families who truly need it.
The work within the government is distributed in such a way that it is I who shall answer the interpellation.
The extra cost allowance shall compensate for extra costs due to functional impairment in children and adults and is an important social insurance benefit. The benefit was introduced on 1 January 2019, when the extra cost allowance and the nursing allowance replaced the benefits of disability allowance or nursing allowance. The reform aimed, among other things, to make the assessment of the conditions for the extra cost allowance clearer and more predictable. There was a need to adapt the benefits to the changes that have occurred within the field of functional impairments and in the design of various social supports. Before the reform, extra costs during applications for disability allowance or nursing allowance were assessed based on a balanced assessment of the individual's need for care or assistance and not, as today, as an independent benefit.
The Swedish Social Insurance Inspectorate, ISF, submitted the report From disability compensation and care allowance to additional cost compensation (ISF's report 2023:1) in March 2023 in response to a government assignment. The review shows that the regulatory framework for additional cost compensation has in several ways become clearer and more transparent than the regulatory frameworks for disability compensation and care allowance.
At the same time, the review shows that over 90 percent of parents who apply for extra cost compensation for a child and approximately 50 percent of the adults who apply for themselves have their applications rejected by Försäkringskassan. ISF assesses that the high proportion of rejections is due to the design of the benefit. Many who apply have difficulty understanding what an extra cost is. ISF's review shows, for example, that many parents receive a total or partial rejection of their application because the costs stated in the application were covered by other social support, such as that provided by municipalities or regions. Parents also apply for compensation even though the sum of the costs they state does not reach what is required to be eligible for extra cost compensation at the lowest level. ISF's recommendation to the government is to consider measures regarding the design of the benefit for children with disabilities if the high proportion of rejections persists over time.
Since the regulatory framework for additional cost compensation is relatively new and knowledge-intensive, it is reasonable to follow to what extent knowledge-enhancing measures and practice contribute to increased accuracy and fewer rejections. The Government has also given ISF an additional assignment which involves evaluating the introduction of the care allowance. The evaluation shall, among other things, include a comparison of the period before the reform, when additional costs were considered in a balanced assessment with the individual's care needs, and current conditions. The evaluation can provide further important knowledge on how the reform affects individuals who are affected by economic consequences due to a functional impairment. ISF shall report on the assignment by October 17, 2025, at the latest.
Jessica Rodén (S)
Mr. Speaker! I thank the Minister for the opportunity to discuss this important issue here today.
The Social Democratic welfare construction has always been built on the principle that society should be there for those who need it the most. The care allowance, which was introduced as early as 1964 by Tage Erlander's government, was an expression of exactly this. It was a support that made it possible for parents of children with different disabilities to manage both the economic and the practical challenges that could arise. It was about solidarity, about equality, and about ensuring that no children or families were left behind.
When the 2019 reform replaced the childcare allowance (vårdbidraget) with the extra cost allowance (merkostnadsersättningen) and the care allowance (omvårdnadsbidraget), the ambition was to modernize the system and make it more legally secure and clear. These intentions were good. But today, when we see that over 90 percent of the parents who apply for the extra cost allowance receive a rejection, we must ask ourselves if we have truly succeeded in living up to the purpose of the reform.
Mr. Speaker! Parents of children with disabilities often face a jungle of rules. There are requirements and bureaucracy. It can be difficult to understand what counts as an extra cost, and the system can perhaps be perceived as dismissive instead of supportive. Then one might be met with a rejection notice explaining that one's costs are already covered by other social supports - without clear guidance being provided on how these supports can be applied for.
I think it is unreasonable that we have a system that demands so much from people who may already be struggling hard to make ends meet. It is clear that the reform needs to be reviewed. We are not going to throw it overboard, but we perhaps need to make adjustments and improvements so that it truly meets the needs that exist.
Mr. Speaker! The Minister points out in his response that it is important to evaluate the reform and gather more knowledge before a major change is made. That is a reasonable argument. But at the same time, parents are here and now with great needs and with a system that they experience as difficult to access and perhaps a bit too bureaucratic.
My question is: What concrete measures can the government and the Council of State take in the short term to facilitate things for these families?
Statsrådet Camilla Waltersson Grönvall (M)
Mr. Speaker! I thank Jessica Rodén very much for an important interpellation. Just like the interpellator, the government and I have a very strong commitment to ensuring that society's most vulnerable and at-risk groups receive the support they are entitled to in a country like Sweden. I am pleased with all the work that both Social Democratic and bourgeois governments have done to make that structure stronger. Naturally, I see, among other things, the LSS legislation as an important milestone in continuing a tradition of making Sweden stronger for people who need society's support.
It is naturally the case that both I and the government are following this very closely. We see the high rejection rate. It is admittedly significantly fewer for adults applying for themselves. But when it is as much as 90 percent regarding children, it is clear that we must acquire a completely different knowledge regarding this. To throw a reform overboard, as the member expresses it, can be foolish to do. Sometimes one needs to tweak different reforms. With new reforms, it is usually so.
This is an important benefit for those who have additional costs due to their own or their child's disability. The Social Democratic government had a good purpose when it worked on this. There was a need to increase predictability and uniformity but also legal certainty in this type of decision.
We are, from the government's side, naturally very keen that this social support should function well. The government has therefore tasked ISF with evaluating this as a complement to the previous review from the previous government's time. The evaluation shall, among other things, include a comparison of the period before the reform, when the additional costs were considered in a balanced assessment with the individual's healthcare needs, and the current conditions.
I am now awaiting this evaluation. It will be presented by October 17th this year at the latest. After that, the government can make assessments of what we may need to do to adjust this reform if required.
Jessica Rodén (S)
Mr. Speaker! I went in and read on the Försäkringskassan website. There is a lot of information and instructions there on how to apply for additional cost compensation and what is counted as additional costs. It can involve medicines, special diets, wear and tear of clothes and furniture, and so on. There is also information on how Försäkringskassan makes its assessments. It is a very large amount of information and a huge amount of figures. There are different levels, different categories, and masses of text. It is a wall of text that meets you. You encounter a system that is difficult to understand. The application process requires extensive documentation. And then it is 90 percent that meet rejection.
As said, the Minister has pointed out that the reform shall be evaluated, which I think is good. But there are already clear indications that the application process or the information regarding it is unclear or difficult to understand. A full 90 percent are rejected. Do we really have to wait for an evaluation before, for example, adjusting the application process or making the information more easy to understand?
Statsrådet Camilla Waltersson Grönvall (M)
Mr. Speaker! I thank Jessica Rodén very much for the question.
Work is currently underway on the part of ISF to conduct an in-depth evaluation which is to be presented by mid-October this year at the latest. I look forward to taking part of this report and the agency's conclusions and recommendations, because it is based on those types of recommendations that we work to ensure that there are well-founded proposals to move forward with.
Just as the interpellator highlighted at the beginning of the debate, the alternative is to scrap a reform. In that case, we need well-substantiated proposals and recommendations to be able to ensure that people receive the safe care that I know both the interpellator, the government, and I myself are keen for them to receive.
We will await the work that is now taking place at ISF. I naturally look forward to having the opportunity to discuss and perhaps debate the conclusions and recommendations that I foresee we will receive.
Jessica Rodén (S)
Mr. Speaker! Today we have discussed a reform that was intended with good intentions but which, in its current form, perhaps does not quite reach the parents who need it the most. I am pleased that the government has taken the initiative to evaluate the additional cost allowance. But one could perhaps work a bit faster, for example, on how the information is presented on Försäkringskassan's website, how the flow of information is used, and so on. It is truly a wall of information that one encounters when entering there.
But I thank the Minister for the debate and look forward to returning.
Statsrådet Camilla Waltersson Grönvall (M)
Mr. Speaker! Thank you, Jessica Rodén, for an important interpellation! This is ultimately about children with disabilities and about the families who already live in a very vulnerable situation and often have great pressure on them.
We can well hope that representatives from Försäkringskassan perhaps listen to this debate and draw conclusions. ISF assesses, however, that the large proportion of rejections is due precisely to the design of the reform and not to Försäkringskassan's assessment. This is something that Försäkringskassan agrees with, i.e., that the proportion of rejections is due to the design of the benefit and not to the agency's application. It might be good to add this in a debate where we have also mentioned this agency.
I naturally look forward to receiving the report that is to come - in that regard, I hope that October comes quickly - and above all, the authority's conclusions and recommendations, so that we can secure these measures for the children and parents who need them most.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.