Eligibility for Publicly Funded Health and Disability Services

Determination of Eligibility

This page provides information on disputes about eligibility for Publicly Funded Health and Disability Services.

• Background
• Determination process

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Background

Eligibility for publicly funded health and disability services in New Zealand is determined pursuant to section 32 of the New Zealand Public Health and Disability Act 2000.

The current Direction of the Minister of Health (Relating to Eligibility for Publicly-Funded Health and Disability Services in New Zealand) came into force on 30 October 2003.

Section 5 of the Direction provides that the Ministry of Health is responsible for determining any dispute about eligibility:

5. Disputes and payments - If any question or dispute arises as to whether or not a person satisfies any of the eligibility criteria, that question or dispute shall be determined by the Ministry of Health.

The Ministry of Health has no discretion to amend the criteria laid down in the Ministerial Direction.

Determination process

The process for making a determination is as follows:

• A panel of three people will make the determination
• The panel will consist of
  
  
  • one policy representative with comprehensive knowledge of the eligibility direction and its application (Chair)
  • one legal staff member
  • one other person as appropriate to the determination required
• Except as set out in this document, the panel will have responsibility for determining its own process
• The parties requiring a determination should forward details of the question or dispute to be determined to:
  
  Senior Policy Analyst
  Primary Health Care Policy
  Ministry of Health
  PO Box 5013
  Wellington
  
  Email: eligibility@moh.govt.nz
• The Senior Policy Analyst will contact each of the parties to the question or dispute to request any additional information needed for the panel to make a determination.
• The determination will not be made until the parties have been given reasonable opportunity to make representations on the question or dispute.
• When all required information has been provided, the information will be provided to the panel for a determination to be made.
• The panel will make a consensus determination, and that determination will be final.
• A copy of the determination will be provided in writing to the parties.

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Page last updated: 29 January 2009