CUME Benefit 2027: Autism, Home Treatment and Extensions

The CUME benefit, the one paid to families who reduce their working hours to care for a child with cancer or another serious illness, has a new regulation. Royal Decree 957/2026 of 4 November, published in the Official State Gazette (BOE) on 5 November 2026, fully replaces Royal Decree 1148/2011 and enters into force on 5 January 2027. It brings very specific changes: treatment at home counts as if it were a hospital admission, level 3 autism spectrum disorder is added to the list of serious illnesses, the exclusion of people who work very few part-time hours disappears, and the recognition periods become longer.

If you are caring for your sick son or daughter and have questions about your reduced working hours or about the CUME benefit, you can write to Fernanda Vargas on WhatsApp or book an appointment on her Calendly. Fernanda Vargas, employment lawyer in Madrid, can review your specific case.

In this guide we explain, with the text of the new regulation in hand, what changes, what stays the same, how to apply for the benefit and what happens to families who are already receiving it.

What the CUME Benefit Is and Why There Is a New Regulation

The economic benefit for the care of minors affected by cancer or another serious illness (prestación por cuidado de menores afectados por cáncer u otra enfermedad grave, known as CUME) compensates the loss of salary of fathers, mothers, guardians with a view to adoption or permanent foster carers who reduce their working hours to provide direct, continuous and permanent care to a minor in their charge during hospitalization or continuous treatment of the illness. It is regulated in articles 190 to 192 of the General Social Security Law (Ley General de la Seguridad Social), and the reduction of working hours that gives rise to it is the one in article 37.6, third paragraph, of the Workers’ Statute (Estatuto de los Trabajadores).

The law already changed a few weeks ago: Royal Decree-law 31/2026 of 20 October made it possible to recognize the benefit even without a hospital admission when the minor needs treatment of equal intensity, opened the door to keeping it beyond the age of 26 in cases of a 65 % disability or grade III dependency, and allowed both parents to receive it, alternately or at the same time. What was missing was the implementing regulation: specifying exactly what a “situation treated as equivalent” is, how it is proven, how the periods are shared and how it is monitored. That is what Royal Decree 957/2026 does now.

If you want to review the earlier changes, we explain them in the article on reduced working hours for a child with cancer and the 2026 reform. This article focuses on what the new regulation adds.

When Royal Decree 957/2026 Enters into Force and What It Repeals

The new regulation enters into force two months after its publication in the BOE, that is, on 5 January 2027. From that day, the following are expressly repealed:

• Royal Decree 1148/2011 of 29 July, the regulation that governed the benefit since 2011.
• Order TMS/103/2019 of 6 February, which amended the annex of Royal Decree 1148/2011 and approved the model medical statement.

Everything is brought together in a single text which, according to its preamble, is structured in nineteen articles, two additional provisions, one transitional provision, one repealing provision, four final provisions and two annexes (the list of serious illnesses and the model medical statement). Until 4 January 2027, the 2011 regulation continues to apply, together with the changes the law has already made.

Treatment at Home: Situations Treated as Equivalent to a Hospital Admission

The benefit requires that the cancer or serious illness involve a hospital admission or an equivalent situation. Article 4 of the new regulation specifies, for the first time, which situations are treated as equivalent to a hospital admission, provided they require direct, continuous and permanent care:

• Hospitalization at home.
• Outpatient or continuous treatment.
• Home care arising from specialized and complex therapies.
• Complex home care that, by medical prescription, has to be direct, continuous and permanent and does not fit any of the previous situations.

For these situations to count as equivalent, two conditions must be met at the same time. The first is that they are proven with the official medical statement, which must expressly state that the treatment or care is not provided in hospital. Article 4.2.b) sets out the second as follows:

«That the absence of hospital admission does not result from a lower intensity of the care required, but from clinical, therapeutic or organizational criteria of the healthcare system.»

In other words: if your child is at home because the hospital organizes their treatment that way, and not because they need less care, the situation can be protected. Both conditions are recorded in the sections that the model medical statement in Annex II includes for this purpose.

School and Work Placements: Compatible with the Benefit

Another very frequent question was whether the benefit is lost when the minor goes back to school. The regulation makes it clear: attending school is compatible with the need for direct, continuous and permanent care when, according to the report of the primary care or specialist doctor of the public health service, treatments, check-ups, crises, monitoring needs, administration of medication, frequent trips to healthcare centers or any other clinical circumstance requiring the effective availability of the carer persist.

What is not compatible is the minor carrying out activities that lead to their registration with Social Security, with one exception: the training placements in the fifty-second additional provision of the General Social Security Law, provided the need for care is still proven.

Level 3 Autism and Other New Additions to the List of Serious Illnesses

Only the serious illnesses included in the list in Annex I give the right to the benefit. The new list adds two conditions:

• Autism spectrum disorder, support level 3 (entry 39 of Annex I).
• Poirier Bienvenu neurodevelopmental syndrome (entry 124).

The first one should be read carefully: what enters the list is autism spectrum disorder with support level 3, not any autism diagnosis. In addition, as with any other illness on the list, the need for direct, continuous and permanent care during a hospital admission or an equivalent situation must be proven with the medical statement.

The list keeps, among others, the oncology section (leukemias, lymphomas, central nervous system tumors and others) and includes open clauses such as entry 40, for «any other serious psychiatric illness», and entry 125, for «any other serious disorder of genetic origin», provided that, on the doctor’s express indication, they require permanent care in a hospital admission or hospitalization at home. The Ministry of Inclusion, Social Security and Migration may add new illnesses by ministerial order, with a prior report from the Ministry of Health.

If the illness relapses, the benefit can be recognized again by providing a new medical statement.

The Medical Statement: Primary or Specialist Care, Also with Private Healthcare

The illness and the need for care are proven with a medical statement that must follow the model in Annex II. There are two new points:

• It can be signed, without distinction, by the primary care doctor or by the specialist doctor of the public health service responsible for the minor’s care. Until now, families usually depended on the primary care doctor; now they can also go to the specialist in charge of the treatment.
• It is required even if the diagnosis and treatment took place in private healthcare. In other words, if your child is treated in a private hospital, you will still need the statement from the public health service.

In Ceuta and Melilla, according to the first additional provision of the regulation, references to the public health service are understood to refer to the National Institute of Health Management (Instituto Nacional de Gestión Sanitaria). In addition, the Ministry of Inclusion and the Ministry of Health will draw up, within six months of the entry into force, a technical guide, for guidance only, so that the assessment of the need for care is consistent throughout Spain.

Part-Time Work: The 25 % Limit Disappears

Under the 2011 regulation, a person with a part-time contract whose actual working hours were equal to or less than 25 % of those of a comparable full-time worker had no right to the benefit. Royal Decree 957/2026 removes that limitation.

From 5 January 2027, people hired part-time are entitled to the benefit provided they reduce their working hours by at least 50 %, and the benefit is recognized in proportion to the percentage of the reduction. To calculate that percentage, the regulation refers to the working hours of a comparable full-time worker in the same company and workplace doing identical or similar work.

If you have several jobs (multiple employment), the benefit is recognized in proportion to the reduction of your total working hours across all of them. And if you are self-employed (autónomo), the percentage is calculated on a working week of forty hours.

For anyone who already had a reduction for legal guardianship before their child fell ill, the percentage of the CUME reduction is calculated without taking that other reduction into account. In the article on reduced working hours to care for children we explain how the ordinary reduction for legal guardianship works, which is a different right.

Both Parents, Separation, Divorce and Alternating Periods

When both parents meet the requirements, the benefit can be recognized to one of them or to both, alternately or at the same time. The regulation sets out how each option works:

• Simultaneous payment: each parent must separately prove the requirements, including their own reduction of working hours, and the application must state this with the details of both.
• Alternating payment: agreed between both parents for periods of no less than fifteen days. While one receives it, the other’s right is suspended.
• Annulment, separation, divorce, end of a registered partnership or gender-based violence: the benefit is recognized to the parent who lives with the minor, even if the other parent does not work. Living together is proven with the municipal registration certificate (certificado de empadronamiento) or any other means of proof accepted by law.
• Shared custody after a breakup: the benefit is paid alternately, in line with the living arrangements.
• Several sick children: both parents can receive it at the same time if each one reduces their working hours to care for a different child.

As a general rule, both parents must be registered and in active status with Social Security (or one of them in a compulsory professional mutual fund). That requirement is considered met, for the parent who does not receive the benefit, if they receive a contributory pension for absolute permanent disability or severe disability (gran incapacidad) or have a special agreement because they work in a country that has no Social Security agreement with Spain. In single-parent families, the benefit goes to the only parent.

Curatorship with full and general powers of representation, including the duties of attending to and caring for the sick person (article 3.2), is also considered a protected situation, as is guardianship by a relative who, under civil law, cannot adopt the minor.

How Much Is Paid and Who Pays

The benefit is a daily allowance equal to 100 % of the regulatory base of temporary disability for occupational contingencies (or for common contingencies, if occupational ones are not covered), applying the percentage by which working hours are reduced. If you cut your working hours in half, you receive 50 % of that regulatory base; your employer keeps paying the salary for the hours you work.

When both parents receive it at the same time for the same child, each one receives 50 % of their own regulatory base, regardless of how much each one reduces their working hours.

There are two technical adjustments:

• Part-time workers: the daily regulatory base is calculated with the contribution bases of the three months before the month preceding the start of the reduction, divided by the calendar days in that period.
• Self-employed workers: the provisional contribution bases taken into account while receiving the benefit are considered final and are not adjusted the following year, although they can be updated at the worker’s request.

The benefit is paid by the mutual insurance company (mutua) or the managing body with which the worker has occupational contingencies covered (article 18.1). Payment is made in arrears, by monthly periods (article 18.2).

As for prior contributions, none are required from anyone under 21 when the reduction starts. Between 21 and 26, 90 days of contributions in the previous seven years are required (or 180 over their whole working life), and from 26, 180 days in the previous seven years (or 360 over their whole working life).

Periods: Four Months, Six Months and Eight-Month Extensions

One of the changes that most relieves families is the length of each period. Until now, the need for care had to be proven again very often; the new regulation makes the periods longer:

Period	2011 regulation	Royal Decree 957/2026
Initial recognition	1 month	4 months
First extension	2 months	6 months
Further extensions	4 months	8 months
Part-time exclusion	No right with working hours equal to or less than 25 %	Removed
Medical Inspectorate report	Not provided for	At 24 months and then every two years

Each extension requires a new medical statement confirming that care is still needed. The extension can be requested within the three months before the recognized period ends or on the same date it ends. If the doctor indicates that care will be needed for a shorter time, the benefit is recognized for the specific period stated in their report.

Up to What Age

The benefit continues until age 23 if, after reaching adulthood, the illness diagnosed earlier and the need for hospitalization or treatment persist. It extends to age 26 if a disability of 65 % or more is proven before age 23. And, exceptionally, it can continue beyond age 26 when the sick person has a disability of 65 % or more or grade III dependency, provided they still live with their carer and the need for care continues to be proven. Living together is not interrupted by temporary respite or short stays in a residential facility or supported housing.

The Medical Inspectorate Report Every Two Years

In exchange for longer periods, the regulation introduces a new check. After the first 24 months from the initial recognition, and every two years from then on, the extension application must include a binding report from the Medical Inspectorate of the public health service confirming the illness and the need for care.

• The Medical Inspectorate has 30 days from your request to issue the report.
• If it does not issue it within that time, the benefit is considered extended and continues to be paid provisionally.
• If the report still has not arrived during the eight months of provisional extension, the benefit ends when that period runs out, unless a new extension has been requested with the doctor’s statement.

If the report is unfavorable, the mutual insurance company or managing body opens a termination procedure: you will have ten days to submit arguments and documents, the Medical Inspectorate will review its report, and the decision must be issued and notified within a maximum of 30 days. It can be challenged with a prior administrative claim before going to the labor court.

How to Apply and What Happens if There Is No Answer

The application is submitted, online or in person, to the relevant mutual insurance company or to the provincial office of the managing body in your province, using the forms they provide in their offices and on the Social Security website. The deadline matters:

• If you apply within three months of the start of your reduced working hours, you are paid from the same day the reduction started.
• If you apply later, the payment only goes back a maximum of three months.

Main documents that must be provided or proven:

• A certificate from the employer with the start date and the percentage of the reduction of working hours (self-employed workers submit a statement of the percentage of reduction over forty hours a week; in domestic employment, a statement from the employer).
• The medical statement in Annex II.
• The family book (libro de familia) or Civil Registry certificate, or the decision on adoption, guardianship with a view to adoption, foster care, guardianship or curatorship.
• If the couple has separated, the decision or document proving it and the municipal registration certificate.
• If payment alternates, the agreement between both parents.
• A certificate from the employer with the contribution base for the month before the month preceding the start of the reduction (for the previous three months, if you work part-time).

The mutual insurance company or managing body must decide and notify within 30 days of receiving the application. Pay attention to this point: if 30 days pass without an express answer, the application is considered rejected. Silence is not a “yes”. You can file a prior administrative claim and then a claim before the labor court.

While you receive the benefit, article 16.1 requires you to inform the mutual insurance company or managing body, within 30 days, of any change that may modify, suspend or end it. It ends, among other cases, if you return to full working hours, if the minor’s condition improves or they are discharged, if either parent stops working (except in cases of breakup or gender-based violence where the parent living with the minor receives it), if the sick person carries out activities that lead to their registration with Social Security (except training placements), if they marry or form a registered partnership (in that case the benefit can be recognized to their spouse or partner) or on death.

Practical Example: A Part-Time Mother with Her Daughter in Hospitalization at Home

Lucía works part-time at a logistics company, ten hours a week, while a full-time worker at her workplace works forty. Her six-year-old daughter is being treated for leukemia. After the first weeks on the ward, the hospital decides to continue treatment through hospitalization at home, because it is clinically the most suitable option, not because the girl needs less care. Lucía wants to reduce her working hours to care for her.

Under the 2011 regulation, Lucía would not have been entitled to the allowance: her working hours were equal to 25 % of those of a comparable full-time worker. If she applies from 5 January 2027, that exclusion no longer exists. She will have to reduce her working hours by at least 50 %, and her daily regulatory base will be calculated with the contribution bases of the three months before the month preceding the start of the reduction, divided by the calendar days in that period. Because the regulation measures the percentage of reduction against the working hours of a comparable full-time worker, with such short working hours it is advisable for Fernanda Vargas to review how it applies to her case before she applies.

Her daughter’s situation fits expressly within article 4.1.a) of the new regulation. The oncologist at the public hospital in charge of the treatment can sign the Annex II statement, stating that the treatment is not provided in hospital and that the absence of admission is due to clinical criteria. The benefit will be recognized for four months; she can then request a six-month extension and, if needed, further eight-month extensions. If treatment lasts more than 24 months, the next extension will require the Medical Inspectorate report.

If the girl’s father also works and decides to reduce his working hours, they could both receive it at the same time. In that case, each would receive 50 % of their own regulatory base, regardless of how much each one reduces their working hours.

What Happens to Benefits That Are Already Being Paid

The single transitional provision settles the situation of those who already have the benefit or have applied for it:

• From 5 January 2027, all ongoing procedures and benefits are governed by the new regulation, without repeating steps already taken, which remain valid.
• When the new regulation is more favorable, it applies first, even to actions taken before its entry into force.
• In applications submitted from that date, a previous hospital admission or equivalent situation can be proven, provided the minor has not been medically discharged since the diagnosis and the other requirements are met. The date of diagnosis does not by itself prevent access to the benefit.
• For ongoing benefits, the Medical Inspectorate report is required starting two years from the last extension granted.
• References to the list of illnesses in the 2011 regulation are understood to refer to the new Annex I, even if the numbering changes.

If your child has been treated at home and you were refused the benefit because there was no admission, or if you were left out because you worked few part-time hours, it is worth checking whether you can submit a new application from 5 January 2027. To understand all your rights while a relative is in hospital, the guide to leave for a relative’s hospitalization may also help, another right that can help you get organized in the first few days.

Every family has different circumstances (type of contract, custody arrangements, mutual insurance company, diagnosis), and these changes can alter the outcome of an application. Fernanda Vargas, employment lawyer in Madrid, can help you prepare the application, arrange the reduction of working hours with your employer or file a claim if it is refused. You can see how she works on her labor law and Social Security page.

Frequently Asked Questions

If you would like us to review your case, write to Fernanda Vargas on WhatsApp or book an appointment on her Calendly: Fernanda Vargas, employment lawyer in Madrid, will help you apply for the CUME benefit or claim it.