What help can you get through the health system or other services?

What services are provided through the Australian health system?
What services can you get through Medicare?
What services can you get through the Pharmaceutical Benefits Scheme?
What if you go into hospital?
Example
Do you have high electricity costs from running medical equipment?
Do you need oxygen?
What if you are in custody?

What services are provided through the Australian health system?

The Australian health system provides services to anyone who needs help to manage their health. These services are called mainstream services. They are available to everyone, whether or not you have a disability. We can’t fund a support if it’s more appropriately funded or provided by one of these services.

Because you can get these services through the general health system, we can’t fund:

health services your state or territory health system or other schemes provide
health services available to all Australians through Medicare, such as doctor and specialist appointments to diagnose or treat health conditions or illnesses
services or supports to manage a health condition that isn’t related to your disability
clinical treatment of any health conditions, including ongoing or chronic conditions
allied health services related to acute and post-acute services
health services to prevent disease and ill health and support a healthier lifestyle for all Australians
direct care supports while you are in hospital
rehabilitation or short-term medical care when you leave hospital
end-of-life and palliative care.

Learn more about mainstream and community supports.

There may also be other specialist health services or private health insurance that is available to manage your health or treat a health condition. You will need to pay for these things yourself.

If you need help to manage your health or a health condition you should talk to your doctor first. If you need help to link to a doctor in your area talk to your my NDIS contact or support coordinator.

Medicare helps all Australians with the costs of their health care. You can access Medicare to help pay for services to manage your health and chronic health conditions, such as diabetes, heart disease or arthritis.

If you have a health condition you should talk to your doctor first. They can link you to health services that are paid for through Medicare. You can continue to access health services from Medicare, even when you are a NDIS participant.

If you have a long-term health condition you should get treatment and services you need through Medicare. For example, if you have asthma you would need to see your doctor for treatment. Your doctor would tell you what medications you may need and information about living with asthma.

The Pharmaceutical Benefits Scheme provides access to necessary medicines for Australians. It covers the costs of medicine for most medical conditions. If you need medicines, the Pharmaceutical Benefits Scheme provides, you should see your doctor who will prescribe what you need.

Some medicines aren’t covered under the Pharmaceutical Benefits Scheme, but we can’t fund these for you. If a medicine isn’t covered under the Pharmaceutical Benefits Scheme, you will need to pay for this yourself.

Talk to your my NDIS contact or support coordinator if you need help to find out more about the Pharmaceutical Benefits Scheme.

While you’re in hospital your state or territory health system are responsible for your care and support needs. For example, personal care or medication. Hospital staff are responsible for providing your care while you are in hospital.

If you have a regular support worker who visits you at home, we won’t fund them to provide care while you’re in hospital. Any care plans that set out your personal care needs can be provided to hospital staff. They can then adapt and follow these plans while you’re in hospital to provide this support.

If you have a disability, you have the right to the same health care as all Australians. The health system needs to adapt its services to meet your disability needs. For example, if you go into hospital, then it’s the hospital’s responsibility to meet your disability-related needs during your hospital stay.

In some cases, if you have complex care needs, we may fund a short period of time for your usual care provider to train hospital staff in your specific needs. Such as, extra training for hospital staff if you have a behaviour support plan or communication plan in place.

If you have funding for a support coordinator or recovery coach, this support can continue while you’re in hospital. Your support coordinator or recovery coach can help you prepare for discharge from hospital. They can also help set up any supports you may need when you leave hospital.

Your my NDIS contact, support coordinator or recovery coach will also work with the hospital as part of the discharge planning the hospital provides.

We may fund disability-related health supports after you leave hospital if:

you need it because of your disability
it is not more appropriately funded by or provided by the health system or another service
you need it to do day-to-day things like showering or eating.

If you need supports for a short time after you leave hospital, your state or territory health system will provide this. This could include things such as check-ups with a doctor after surgery, care until a wound heals or rehabilitation.

Abdul has autism. He had severe pain in his stomach and went to the emergency department at his local hospital. The doctor said the pain was from appendicitis. Abdul stayed in hospital to get his appendix removed.

Abdul’s support worker took Abdul’s communication and behaviour support plan to the hospital. The support worker helped to get Abdul settled and explained Abdul’s communication and support needs to the hospital staff. The hospital staff followed Abdul’s care plans and provided his personal care while he was in hospital.

After the surgery Abdul stayed overnight and left hospital the next day. Over the next few days Abdul had a check-up with his doctor. A nurse also visited him at home to check his wound and give him antibiotics. Abdul’s local health system provided these services.

Do you have high electricity costs from running medical equipment?

Some disability-related medical equipment we fund may use more than the average amount of electricity. If you have high electricity costs from the use of medical equipment there are other government schemes that can help pay your electricity costs.

Talk to your my NDIS contact or support coordinator if you need help to access another government scheme to help pay for your high electricity costs.

Do you need oxygen?

Your state or territory is responsible for providing you with oxygen supply and related equipment. Because you can get oxygen supply from your state or territory, we generally won't fund it.

Talk to your my NDIS contact or support coordinator if you need help to link to your state or territory oxygen scheme listed below.

What if you are in custody?

If you are in custody, for example in prison, a youth detention centre or other setting ordered by the court, the justice system provides your day-to-day care and support needs. This includes your health support needs. Any disability-related health supports and personal care you need should be provided by the facility you are in.

Talk to your my NDIS contact or support coordinator if you’re about to be released from custody. We can support your disability related needs for your transition back into the community.

Learn more about supports when you’re in the justice system.

What help can you get through the health system or other services?

On this page:

What services are provided through the Australian health system?