Our handy guide answers many of the most common questions about the NDIS.
With seemingly endless criteria and requirements – and terminology – it’s not surprising that understanding the NDIS can be a challenge, and the cause of frustration for many people living with disability and their loved ones.
We create this guide to help you and your family gain a better understanding of the NDIS – a one-of-a-kind scheme created to improve disability care and support in Australia.
Let’s start with 5 NDIS quick facts
- The NDIS stands for the National Disability Insurance Scheme. The NDIS was established under the National Disability Insurance Scheme Act 2013, which also launched the National Disability Insurance Agency (NDIA), an independent Commonwealth Government agency that runs the NDIS.
- The NDIS provides funding to eligible people with permanent and significant disability to help them achieve their personal goals and have greater choice and control over how they live their life. As with many Australian government social policy programs, like Medicare and the Pharmaceutical Benefits Scheme, NDIS recipients are not means tested.
- NDIS participants – Australians who receive NDIS funding – are involved in the planning and delivery of their supports and can choose who provides them, as well as when, where, and how often.
- NDIS support providers are regulated by the NDIS Quality and Safeguards Commission and must meet its strict safety and quality standards (Better Rehab is a registered NDIS provider that meets these standards).
- The NDIS takes a lifetime approach, meaning it provides supports early in a person’s life to improve their outcomes in later life. As an ‘insurance scheme’, expenditure is factored in over the life of a participant.
Who is eligible for the NDIS?
The NDIS has a comprehensive assessment process to determine who can receive funding. The main eligibility criteria include: –
- you must be an Australian citizen, a permanent resident or a Protected Special Category Visa holder,
- be under 65 years of age when you apply,
- and have a permanent and significant disability that affects your everyday life and meet the disability or early intervention requirements
Permanent means your disability is life-long and the NDIS defines significant disability as causing physical, intellectual, cognitive, neurological, visual, hearing or psychosocial impairment that affects your ability to take part in daily activities, social activities and work.
How to receive NDIS funding
To receive NDIS funding, your disability must greatly reduce your ability (also called ‘functional capacity’) to perform a range of daily activities in one or more of the following areas: –
- Communicating (how you speak, write, use sign language and gestures compared to other people your age, and your ability to understand others, and how others understand you).
- Learning (how you learn, understand, and remember new things and practice and use new skills).
- Mobility (how easily you move around and use your arms and legs).
- Socialising (how you make and maintain friendships, interact with your community, and cope with feelings and emotions in social settings, or if you are applying for funding for your children, how they play with other children).
- Self-care (how you manage your personal care, hygiene and grooming as well as eating, drinking and health).
- Self-management (for those older than six years of age). This is your mental ability, not physical ability, to organise and manage your life including how you plan, make decisions, and look after yourself and may include daily chores, problem solving, and money management).
How you manage daily activities and tasks is a major focus of the NDIS’ assessment process, so much so if you answer ‘Yes’ to its eligibility checklist question ‘Do you usually need disability-specific supports to complete daily life activities?’ you may be eligible’ for funding.
Does the NDIS support young children?
The NDIS’ Early Childhood Approach (ECA) supports children younger than six with developmental delay and children younger than nine with disability.
It has been designed to support both the child and their family, with a focus on giving the child the best possible start in life.
Children younger than six with developmental delay do not need a diagnosis to receive support through the ECA, which means that there is no delay in the provision of intervention, which is specialised supports. Instead, early childhood and paediatric allied health professionals work with children and their families to determine the supports needed to promote their development.
The NDIS follow the Best Practice In Early Childhood Intervention’s guidelines, that support early childhood intervention providers across the country to apply best-practice approaches. Providers include early childhood teachers, educators, and allied health providers like Better Rehab, to apply best-practice approaches.
What does the NDIS provide funding for?
This is a common question as the NDIS has strict and specific ‘rules’ about which supports participants can use their funds for. And while the NDIS states that your funds can pay for supports in the areas of education, employment, social participation, independence, living arrangements, and health and wellbeing, not every support in these areas meets the NDIS’ funding criteria.
Thankfully you are not expected to know all the supports that the NDIS will fund off the ‘top of your head’ and the NDIS, particularly your local NDIS representative can provide guidance when you are unsure of whether a support can be paid for out of your fund.
To help you understand which supports the NDIS will funds, here are some basic ‘ground rules’ to keep in mind:
For a support to be funded by the NDIS, it needs to be ‘reasonable and necessary’ for each participant.
‘Reasonable and necessary’ basically means a support that is:
- related to your disability needs and
- meets all of the NDIS funding criteria, which includes:
- it will effectively assist you with achieving your goals, including reducing disability-related barriers that stop you participating in activities, social events, work, and study;
- it helps maintain your informal supports (such as family)
- it is value for money (meaning the cost of the support is reasonable relative to the benefits it provides and the cost of alternative supports, and the support is likely to reduce the costs of funding for other supports in the future);
- legal and safe and abide by current good practice;
- not better funded or provided by another service or organisation (such as Medicare);
- it is the responsibility of the NDIS to fund;
- reasonable for the participant’s family, friends and community to provide.
For example if the NDIS find that Occupational Therapy and Physiotherapy are supports that are reasonable and necessary for you, you can use your funds for these allied health services. Same goes for other allied health therapies including Speech Therapy, Positive Behaviour Support and Exercise Physiology.
And if you have a carer to assist you with self-care, a wheelchair, and modifications to your home and car are deemed reasonable and necessary for you, you will receive funds for these supports and services.
The NDIS has divided supports into three main categories:
1. informal supports, such as family, friends and neighbours;
2. community supports such as community, religious and sporting groups;
3. mainstream supports which include health and allied health, education, and other government services such as Medicare and Centrelink.
And there are three types of NDIS support budgets that relate to your personal needs and goals, which are:
- Core supports budget which is the most flexible as you can generally use these funds allocated for one category to pay for another. Categories include Consumables (items for everyday use), Daily Activities (such as assistance with self-care), Assistance with Social and Community Participation, and Transport (for example if you are unable to use public transport because of your disability).
- Capacity Building budget, which has eight support sub-categories including: Choice and Control (which can include training in planning and plan management); Daily Activity (such as therapy to help build capacity to participate in activities); Employment; Health and Wellbeing; Home Living (for example to secure appropriate accommodation); Lifelong Learning (including assistance with the transition from school to further education); Relationships (such as Positive Behaviour Support strategies to reduce behaviours of concern); and Social and Community Participation. Support Coordination can be included in this budget.
- Capital Support budget which funds supports such as assistive technology (AT) or modifications to your home and car. AT includes equipment for mobility, personal care, communication, and recreational activities such as wheelchairs, walkers and augmentative and alternative communication devices (AACs).
Do I pay tax on my NDIS funds?
According to the ATO, NDIS payments are tax-free however you can’t claim deductions for expenses or assets you buy with your funds. For example, you can’t claim deductions for a decline in value of your home and car, renovations and repairs to your property.
If you buy assets to produce income with your NDIS funds, the income isn’t tax-free and may incur capital gains tax.
For further information on your tax responsibilities, visit the ATO.
What isn’t funded by the NDIS?
The quick answer to this common question is the NDIS doesn’t fund supports that are not related to your disability, are likely to harm you or others, can be used as income replacement, or are daily living costs unrelated to your disability.
This ‘not funded’ list typically includes groceries, personal computers (including laptops and tablets), smart phones, utilities (including electricity, gas, internet costs), rent and mortgage repayments, clothing, general household items, such as tables, refrigerators and cooking utensils, medication, dental and general medical services and treatments, as well as specialist services, hospital care, surgery and rehabilitation (that are unrelated to your disability).
Motor vehicles are typically not considered disability-related supports by the NDIS so your funds cannot be used to purchase a vehicle or register, insure, maintain and run it. The scheme, however, can provide funds for modifications to your car to help you drive safely and competently, such as assistive technology to help you get in and out of your car, transport your wheelchair, and use the steering wheel and the other controls.
What are NDIS plans and how do they work?
A plan is a written agreement between the NDIS and each participant that outlines the supports they need. As everyone’s needs differ, each plan is different.
Each participant creates their plan with their local NDIS representative who asks them questions to discover their personal goals and work out what supports they need.
We recommend collecting all the information about your current supports, including provider details, and writing down the supports and services you would like to have to help you achieve your goals. This pre-planning is important as the information you provide the NDIS in your initial meetings plays a role in determining your funding.
In your first NDIS planning conversation, you may be asked by your local NDIS area coordinator how your current community, family and other supports help you manage your daily activities, and whether you use any equipment to help you perform tasks and be more mobile.
This conversation, which can be in person, over the phone, or, in some areas, via video conferencing, is also an opportunity for you to ask questions you may have about your plan, such as how to manage it, and if you think you will need assistance, discussing management options, for which there are three.
Who can help me manage my NDIS plan?
Managing an NDIS plan is similar to managing a small business! There are the ‘suppliers’ – providers – and financial tasks including sourcing quotes from providers, organising when, where and how often they will deliver their services or products, making payments, filing receipts and keeping track of your plan budget.
Given all these tasks, it might be a relief to know that participants have the option to self-manage their plan or have the NDIA or a Plan Manager manage all or part of it for them.
It’s important to know that your Plan Manager will be paid out of your fund and that they need to belong to a registered plan management provider. Plan managers typically pay for your providers, help you stay up to date with your funds, and perform the financial reporting to the NDIS.
You can also have a local Support Coordinator help you manage your plan and participate more in your community. Support Coordinators can assist you in many ways, from connecting you with local supports to helping you with budgeting, service agreements, and plan reassessment meetings. You do however need to check whether your plan will fund a support coordinator.
Local area coordinators can also help you manage your plan. Their knowledge of your local disability services and community can help you choose the right supports for you. For children under the age of seven with developmental delay or disability, Early Childhood partners provide supports that meet the requirements of the NDIS’ early childhood approach.
If you’re unsure which option to go with, your local NDIS coordinator can help you choose a management ‘style’ that suits you and your needs and circumstances.
And remember, your first plan isn’t your ‘forever’ plan. It is regularly reassessed by the NDIS, to ensure it continues to meet your needs. Plans are usually reviewed every 12 months, however you can request a reassessment at any time to adjust your existing plan or create a new plan.
How do I apply for the NDIS?
To start your application for the NDIS, simply call the NDIS National Contact Centre on 1800 800 110 to be referred to your local NDIS coordinator – or if it’s for your child, the early childhood (EC) partner in your area.
Your local coordinator or EC partner can help you apply for the NDIS for yourself or your child. They will ask you about your situation and help you gather information and evidence that proves you or your child is eligible for funding, such as proof that you are an Australian citizen or permanent resident, that your disability is permanent and significant, and an explanation of your or your child’s functional capacity (the ability to perform everyday activities), and your current supports.
The NDIS states that they will inform you of their decision within 21 days in a letter, which is called an ‘access decision’. If the NDIS requests additional information, it gives you 90 days to prepare and submit it, with the assistance of your local coordinator or EC partner. The NDIS makes a decision based on this extra information within 14 days.
If you disagree with the NDIA’s decision, you can apply for a review by the Administrative Appeals Tribunal (AAT).
If you are eligible, your local coordinator or EC partner will arrange a planning meeting to discuss your support and funding requirements and how you would like to manage your or your child’s plan. The information gleaned from this meeting will help create your first NDIS plan, which is an outline of the types of support you need to help you achieve your goals and funding amounts.
