What does the NDIS pay for and how does it work?

For Australians who live with a disability, NDIS funding can be a game-changer that allows access to services to develop skills and live a more enriched, independent lifestyle.

One in six Australians – about 4.4 million of us, live with a disability, according to federal government data. Along with the daily challenges that a disability can bring, living with a disability can also be expensive. A 2020 report in the Health Economics Review journal noted that managing a disability in Australia can consume around 37% of an adult’s disposable income.

This is where the National Disability Insurance Scheme (NDIS) can play a vital role. It is a national scheme that provides funding directly to individuals living with a disability. Rather than being a welfare system, the NDIS is designed to help people with a disability get the support they need to build their skills and improve their independence over time.

As a guide to the scale of NDIS activities, in May 2022, $2.78 billion was paid in participant support, which works out to an average of $54,8 00 per participant.

So, what exactly is the NDIS, who is eligible and what does it pay for to help support those with a disability in Australia?

What is the NDIS?

According to the NDIS website, it is a federal government-funded scheme which provides support to people with an intellectual, physical, sensory, cognitive (such as defective short-term memory) or psychosocial (arising as a result of a mental health condition) disability, as well as early intervention supports for children with developmental delay.

Following trials for the NDIS that first began in 2013, the Scheme is now available across Australia. Over 518,000 Australians who have a disability are currently accessing the NDIS as of 31 March 2022, including almost 300,000 Australians who are being supported for the first time.

The National Disability Insurance Agency (NDIA), which runs the NDIS, decides if a person is eligible to be an NDIS participant, and how much funding they will receive. From there, Local Area Coordinators (LACs), or early childhood partners help participants access, understand and navigate the NDIS system, and create, implement and review a personal plan. Participants can find an NDIS partner office in their area using the search tool on the NDIS website.

What does the NDIS pay for?

The NDIS can help with support funding for individuals based on their needs, including daily personal activities, transport and mobility (such as wheelchairs), access to work and education, household tasks, home and vehicle modifications and therapeutic support. Specific examples of things that may be funded under the NDIS include wheelchairs, speech pathology appointments and healthy meal delivery services.

The NDIA explains there are three types of NDIS “support budgets” that may be funded in a person’s NDIS plan:

1. The “core supports” budget, which includes consumables (everyday items such as continence aids), low-cost equipment to improve mobility (such as a walking stick), help with daily activities (such as household cleaning and yard maintenance), social and community participation and transport.
2. The “capacity building” budget includes helping participants achieve their goals in areas such as employment (help to find and keep a job), health (exercise and diet advice), education (assessment and training to move from school to further education) relationships (advice to develop positive behaviours and interact with others) and living arrangements (help with finding a place to live); and
3. The “capital support” budget, which is used to fund assistive technologies such as wheelchairs or vehicle modifications, and modifications to homes such as the installation of a hand rail in the bathroom or ramp into the home.

Who is eligible for the NDIS?

The NDIS is available to Australian citizens, permanent residents and special-category visa holders who live in Australia, are aged between seven and 65 years old, and who have a disability caused by a permanent impairment. Based on the NDIS criteria, to be eligible you must either:

• need disability-specific support from another person or special equipment to complete daily life activities, or
• require supports to either reduce your future needs, or
• require supports for your family to build their skills to help you.

You can check your eligibility through the NDIS website.

How do you apply for NDIS funding?

The NDIS website advises that if you believe you are eligible, the first step is to phone the NDIA on 1800 800 110 and make an access request. Or you can head to your local NDIS office, or complete an online application form. As part of your application, you’ll need to confirm your identity and verify your residency and eligibility.

During the application process, you will be asked to provide evidence of your disability. This may include documents confirming your primary disability, how this disability impacts different areas of your life, descriptions of past treatments and outcomes, and future treatment options and their expected outcomes. This evidence can be completed by your treating health professional such as a GP, paediatrician, psychologist or allied health practitioner. This evidence should also include your date of diagnosis, details about how long the disability will last, and the treatments that are available.

If your application is accepted, you will then attend a planning meeting, where your needs and goals will be discussed. It is a good idea to take any relevant reports or assessments along with you to this meeting, to help ensure the resulting plan is right for your needs. After the meeting, the NDIA will process and approve your plan, which will be forwarded to you by mail or email.

How much NDIS funding can you get, and who manages it?

There is no set amount of funding you will receive under the NDIS, according to the scheme’s website. Instead, participants develop an NDIS plan based on their individual needs and circumstances, in which they can request funding for ‘reasonable’ and ‘necessary’ support and services. This will then be reviewed and approved by an NDIA professional.

If you decide to self-manage your NDIS plan, you’ll be responsible for tasks such as buying the supports your require, making appointments, managing your funding, keeping invoices and receipts, and being able to show how you’ve used the funding when your plan is reviewed – usually once every 12 months. You will also need to advise the NDIA of any changes to your circumstances, and participate in payment auditing, if required.

If you decide not to manage the plan yourself, or are unable to do so, there is help available. You can choose to work with a plan manager from a registered provider (an individual or organisation delivering a support or product registered under the NDIS Commission) who will help you with the above tasks. You can find a registered provider by using the Provider Finder tool in your NDIS myplace portal or checking on the NDIS website.

Alternatively, you can choose to have the NDIA manage your plan, which is called agency management. The plan-managed or agency-managed options won’t cost you anything out of pocket, as the NDIA pays your plan manager or manages the plan itself using the NDIS funds allocated to you.

A parent, guardian or other responsible adult can manage an NDIS plan on behalf of a child aged under 18. Adult NDIS participants who are deemed not to be capable of managing their plan themselves can still use the self-management option. In this case, a nominee will be appointed by the NDIA to act or make decisions on behalf of the participant.

What assistance is not covered by the NDIS?

Some types of supports that are not covered by the NDIS include general living expenses such as rent, bills, food and entertainment, as well as direct school or study costs (such as general fees or stationery and books required by all students), according to the website. The NDIS also doesn’t cover supports that are already funded or partially covered by Medicare, such as visits to the GP, X-rays or blood tests. You may be able to have these items bulk-billed, although some types of appointments or tests may attract a fee, so it’s always a good idea to check this beforehand.

While you can get dietary or exercise advice related to your disability, the NDIS doesn’t fund gym memberships. Additionally, any home modifications claimed under the NDIS must be directly related to your disability.

How does the NDIS affect Centrelink payments and other benefits?

According to the NDIS website, any funding you receive from the NDIS is separate from a Disability Support Pension, so it won’t affect any disability support, income support or child support payments you may receive (or pay) through Centrelink.

An exception to this can be transport-related supports that form part of your NDIS plan, which may impact a Centrelink Mobility Allowance. However, you’ll still be able to keep your Health Care Card, if you’re eligible for one.

If you’re unsure how the NDIS may affect your existing payments or entitlements, contact the NDIA or Centrelink.

Can you use NDIS funding on holiday?

You can use your usual NDIS funding while on holiday, or to make your holiday activities more accessible. According to the website, the NDIS, however, does not pay for expenses such as flights, accommodation or entertainment that are incurred by travellers, only expenses directly related to your disability.

Cover image source: wavebreakmedia/Shutterstock.com.