Community Health Program access policy

The Community Health Program is funded by the Victorian Government and provides nursing, allied health and counselling services to the Victorian community.

Access to the Community Health Program is targeted to those with the greatest risk of poor health and the greatest economic and social need, who may face barriers to accessing care through other services and in other settings.

Community Health Program eligibility criteria

The following people, including children and young people, are eligible to receive services through the Community Health Program:

• People who hold a healthcare or pensioner concession card, or who are a dependent of a concession card holder
• People with a low or medium income (refer to the fees policy for income levels)
• Aboriginal and Torres Strait Islander people
• Refugees and people seeking asylum
• People who are homeless or at risk of homelessness
• Children in care, child protection, Orange Door and ChildFIRST clients

Principles

When making decisions about access to services through the Community Health Program (CHP), Community health services (CHSs) must apply the following principles:

• Waive eligibility criteria where, due to factors related to intersectionality and/or individual circumstances, an individual faces barriers to accessing alternative safe, inclusive and/or accessible services.
• Waive eligibility criteria where the CHSs is the only local provider of a particular service.
• May restrict access to the CHP where an individual is also receiving funding for the same service through another funding source, for example, NDIS or My Aged Care or other sources.
• Must not restrict access to the CHP based on a person's eligibility for another funding stream or program, where that person is not in receipt of a service or funding. Community health services should support people to access appropriate funding streams and programs, and where practicable and required, provide interim services.
• Must not restrict access to the CHP based on where people live or work, however, may prioritise access for people who live or work in the local area. In determining priority, CHSs should seek to understand an individual’s motivation for travelling outside of their local area, and whether a closer service exists. CHSs may apply geographical restrictions where services are provided outside of the CHS setting, such as home-based and outreach services.
• Should ensure that fees are collected from all CHP clients with the ability to pay, in accordance with the Community Health fees policy. CHSs must not deny anyone a service because of their inability to pay.
• Maintain an open waitlist for eligible CHP clients. People placed on a waitlist must be provided with clear guidance on expected wait times, as well as alternative service options, to ensure that they can make an informed choice about whether or not to wait. CHSs must actively manage waitlists, checking-in on clients at regular intervals to provide updates on wait times and identify any change in the client’s condition that might necessitate a higher priority for service.
• CHSs that accept fee-paying clients outside of the CHP, must ensure adequate resources are directed to service CHP clients, in line with CHP funding and target hours. Private clients must be billed appropriately to ensure that one hundred percent of CHP funding is directed to CHP clients and target hours.
• Once eligibility is confirmed, CHSs should consider an individual's clinical and social needs to prioritise access for services using the guidance provided in the Demand Management Toolkit.