Core Cities Targeted under Medical Care Child Support Act from April 2027

In the Official Gazette dated October 23, 2026 (Reiwa 8), the government promulgated a Cabinet Order (Cabinet Order No. 332) designating “cities specified by Cabinet Order” under Article 14, Paragraph 1 of the Act on Support for Children with Medical Care Needs, Persons with Severe Motor and Intellectual Disabilities, and Their Families as Core Cities. The applicable cities will be subject to the provisions of said paragraph starting April 1, 2027 (Reiwa 9). The promulgation was carried out by the Cabinet, signed by Prime Minister Sanae Takaichi and Minister of Health, Labour and Welfare Kenichiro Ueno.

The legal basis is Act No. 81 of 2021 (Reiwa 3), namely the Act on Support for Children with Medical Care Needs, Persons with Severe Motor and Intellectual Disabilities, and Their Families. Article 14, Paragraph 1 of said Act delegates the scope of the “cities” subject to application to a Cabinet Order, and this Cabinet Order has now finalized that scope. Core Cities are cities designated based on Article 252-22, Paragraph 1 of the Local Autonomy Act (Act No. 67 of 1947); they possess administrative authority second only to designated cities and handle regional health administration as cities that establish public health centers.

Summary of Targets Defined by the Cabinet Order and Legal Basis

The body of the Cabinet Order consists of a single sentence, explicitly identifying the targets as Core Cities, with the enforcement date placed in the supplementary provisions. The primary items are as follows:

• Name: Cabinet Order Specifying the Cities Prescribed by Cabinet Order under Article 14, Paragraph 1 of the Act on Support for Children with Medical Care Needs, Persons with Severe Motor and Intellectual Disabilities, and Their Families
• Number: Cabinet Order No. 332
• Promulgation Date: October 23, 2026 (Reiwa 8) (as per the Official Gazette of the same date)
• Legal Basis: Article 14, Paragraph 1 of Act No. 81 of 2021 (Reiwa 3)
• Target: Core Cities under Article 252-22, Paragraph 1 of the Local Autonomy Act
• Enforcement Date: April 1, 2027 (Reiwa 9)
• Signatories: Prime Minister Sanae Takaichi, Minister of Health, Labour and Welfare Kenichiro Ueno

Positioning of the Support System Handled by Core Cities

Through this Cabinet Order, the “cities” stipulated in the paragraph have been organized as Core Cities rather than prefectures. The legal framework is now clarified such that Core Cities, as cities establishing public health centers, shall be the primary entities implementing support for children with medical care needs, persons with severe motor and intellectual disabilities, and their families.

The targets are determined not by individual designation, but by a method that directly references the classification under the Local Autonomy Act. Consequently, any city that transitions to a Core City in the future will automatically become subject to the paragraph at the time of transition. Conversely, municipalities other than Core Cities are not included in the “cities specified by Cabinet Order” under said paragraph.

Preparation Period Until Enforcement and Impact on Local Governments

There will be approximately five and a half months between promulgation and enforcement. The applicable Core Cities will need to proceed with creating the necessary infrastructure—such as consultation support systems, coordination with related agencies, and securing personnel—by the enforcement date.

For children with disabilities and their families, this means that the available support systems will change depending on whether the city they reside in is a core city. Since all core cities nationwide will be uniformly targeted, the impact will not be limited to specific regions but will be widespread.

This cabinet order serves to finalize the target entities in order to move the legal framework into the operational stage, establishing the scope of cities responsible for the practical implementation of support. Following the enforcement date, the progress of system development within each city will be called into question.

Sources

• Official Gazette, Friday, October 23, 2026, Cabinet Order No. 332, “Cabinet Order Specifying the Cities Prescribed by Cabinet Order under Article 14, Paragraph 1 of the Act on Support for Children Requiring Medical Care, Persons with Severe Motor and Intellectual Disabilities, and Their Families”
• Act on Support for Children Requiring Medical Care, Persons with Severe Motor and Intellectual Disabilities, and Their Families (Act No. 81 of 2021), Article 14, Paragraph 1
• Local Autonomy Act (Act No. 67 of 1947), Article 252-22, Paragraph 1