What does the NDIS pay for?

17 December 2019
There are currently more than 4.4 million Australians living with a disability, according to federal government data, and until recently there was no nationwide system in place to support their needs.

A report by the Productivity Commission in 2011 recommended the Federal Government create a national scheme to provide greater choice and certainty to people living with a disability, after finding the existing system was “underfunded, unfair, fragmented and inefficient”.

In 2013, legislation was passed to create the National Disability Insurance Scheme (NDIS), managed by the National Disability Insurance Agency (NDIA), to provide and co-ordinate disability support funding. As of November 2019 there were 310,000 Australians participating in the NDIS, according to the NDIS Quarterly Report. For 114,000 of these people, it’s the first time they’ve been able to access the support they require.

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 financial 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.

Trials for the NDIS were held in 2013, and it is currently being rolled out around the country, with the final stages of this rollout expected to be completed by 2020.

The government expects the NDIS to provide support for about 460,000 Australians who have a disability when it is fully operational. Individuals with NDIS funding primarily deal with Local Area Coordinators (LACs), Early Childhood Early Intervention (ECEI) co-ordinators, or NDIA planners who help participants access, understand and navigate the new system, and create, implement and review their plan. Participants can find LACs, ECEIs and NDIA planners in their area using the search tool on the NDIS website.

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What does the NDIS pay for?

The NDIS can help pay 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:

  • The core supports budget, which includes consumables (everyday items such as continence aids), low-cost equipment to improve your mobility (such as a walking stick), help with daily activities (such as household cleaning and yard maintenance), social and community participation and transport;
  • The capacity building budget, which 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
  • The capital support budget, which is used to fund assistive technologies such as wheelchairs or vehicle modifications, and modifications to your home, 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 permanent and significant disability. Based on the NDIS criteria, a permanent and significant disability means you either need support from another person, use special equipment or require supports to reduce your future needs. You can check your eligibility through the NDIS website.

NDIS eligibility
Source: Jaren Jai Wicklund (Shutterstock)

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, which runs the scheme, on 1800 800 110 and make an Access Request. When you call, you’ll need to confirm your identity and will be asked questions to verify your residency and eligibility. If you’re already receiving disability support services, the NDIA will contact you when NDIS funding becomes available in your area, if it isn’t already.

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 the expected outcomes of these. 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. Be sure to take any relevant reports or assessments along with you to this meeting, so the resulting plan is right for your needs. After the meeting, the NDIA will process and approve your plan, and your ECEI co-ordinator, LAC or NDIA planner will let you know when this is complete.

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.

NDIS planning
Source: WAYHOME studio (Shutterstock)

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 (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 NDIS manage your plan which is called agency management. These options won’t cost you anything, as the NDIA pays your plan manager.

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 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 stationary/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, transport-related supports form part of your NDIS plan, so if you are receiving a Centrelink mobility allowance, this will cease when your NDIS funding is approved. However, you’ll still be able to keep your Health Care Card, if you’re eligible for one.

The funding you receive from the NDIS is not considered taxable income, and as such won’t affect any disability support, income support or child support payments you may pay or receive, according to the Australian Taxation Office. If you’re unsure how the NDIS may affect your existing payments or entitlements, contact the NDIA or Centrelink.

NDIS centrelink
Source: B-E (Shutterstock)

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.

Emily Boyd Canstar

About Emily Boyd

Emily Boyd is a freelance journalist and editor from Melbourne. She has a Masters degree in International and Community Development, and is a self-confessed research nut who loves to take tricky topics and make them more accessible and digestible to empower her readers. She’s also a mum of three and an enthusiastic amateur baker.


Cover image source: realpeople (Shutterstock)

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