What Does NDIS Cover?

For the more than 4.4 million Australians living with some type of disability according to the latest Australian Bureau of Statistics (ABS) data, the NDIS has the potential to significantly improve day-to-day life quality, offering greater independence, new skills, and access to assistive technology and services that deliver support tailored to individual needs. But what exactly does the scheme cover, and how can you check if you’re eligible?

In this article, I delve deeper into the NDIS, cover the eligibility criteria, and explore some of the specific supports and services included in NDIS plans. Whether you're considering applying or are supporting someone who is, this guide will help you understand what the NDIS can offer. 

What is The NDIS?

The National Disability Insurance Scheme (NDIS) is a program in Australia designed to provide support and assistance to individuals with permanent and significant disabilities. It is a government-funded initiative that empowers those who live with intellectual, physical, sensory, cognitive, psychological, and developmental delays by giving them more choice and control over the support and services they receive.

The NDIS was introduced to address the shortcomings of the previous disability support system in Australia, providing a more personal and goal-centred approach. This scheme ensures that support is not just reactive, but also proactive, enabling participants to achieve long-term goals such as employment, education, and community participation. It focuses on providing long-term support to individuals with disabilities, aiming to enhance their independence, social participation, and overall quality of life.

What Services Does NDIS Provide? 

The NDIS offer various types of support and services that fall into the following three categories: 

• Core Supports Budget — This budget category covers funding for everyday supports and services that help NDIS participants with their daily activities, living costs, community participation, and personal care. This budget is highly flexible, allowing participants to choose how to allocate their funding across a range of supports, depending on their needs at any given time. It may include support such as assistance with personal care and NDIS consumables, transportation, social and recreational activities, and support workers. The Core Supports budget is designed to provide flexibility and cover a range of essential disability supports.

• Capital Supports Budget — The Capital Supports budget is allocated for higher-cost items and equipment that are necessary to enable a participant to achieve their goals. This budget category covers funding for assistive technology, home modifications, vehicle modifications, and other capital items. It aims to provide participants with the necessary tools and resources to enhance their independence and quality of life. Examples include mobility aids like wheelchairs, home accessibility modifications like ramps, and vehicle alterations to accommodate a participant’s specific needs.

• Capacity Building Budget — The Capacity Building budget is intended to fund supports and services that help participants develop their skills, capabilities, and independence over the long term. This could include anything from life skills development and employment training to health and well-being programs. It includes funding for various therapies, training, skill development programs, and support coordination. The Capacity Building budget is focused on empowering participants to achieve their goals, improve their well-being, and increase their participation in the community.

 

Eligibility Criteria for NDIS Coverage

While eligibility for NDIS services is determined on a case-by-case basis that is tied to a personal NDIS plan, there are certain prerequisites that must be fulfilled before you can apply. Below, we list the main eligibility criteria for NDIS coverage: 

• Age — You must be between the ages of 7 and 65 to apply for NDIS funding. For children under 7, the Early Childhood Early Intervention (ECEI) program offers tailored support, which transitions into the NDIS as the child grows. Other support is available to those who fall outside the age range.
• Residence — You must be an Australian citizen, permanent resident, or hold a Protected Special Category visa to apply for NDIS support. This ensures that the scheme is available to those who are legally entitled to long-term residency in Australia.
• Living Situation — You must be living in Australia to access NDIS support. Temporary absences from the country (such as holidays) are generally permissible, but ongoing support requires that your primary residence remains in Australia.
• Disability Status — You must have a disability that is caused by a permanent impairment. This can be intellectual, cognitive, neurological, sensory, physical, or psychosocial disability. The impairment must substantially reduce your ability to perform everyday activities and require lifelong support.

Other eligibility requirements include whether you need support for daily living, whether you require early intervention support to reduce the need for future support, and whether you require support for your family to build the skills needed to help you. However, each of these criteria is judged on your application. It's also important to note that having a disability does not automatically qualify you for NDIS support; the impairment must have a significant impact on your life.

What Falls Under the Coverage of the NDIS?

Under the NDIS, eligible participants are assessed based on their individual support needs and goals, and then allocated funding to access a range of supports and services that are tailored to their specific requirements. These supports can include things like personal care, therapy, assistive technology, home modifications, and participation in community activities.

Individually tailored plans may cover the following, however, it’s important to note that the specific supports and services provided under the NDIS can vary depending on the individual's needs and goals. Each NDIS plan is unique, designed to meet the specific circumstances of the participant, ensuring that they receive the right level of support for their situation.

• Daily living support — This includes assistance with personal care, household tasks, meal preparation, and other activities of daily living. Such support ensures that participants can maintain a good standard of living and manage their day-to-day needs independently or with minimal assistance.
• Therapy services — The NDIS can fund various types of therapy, such as occupational therapy, speech therapy, physiotherapy, and behaviour support. These therapies aim to improve functional abilities and enhance overall well-being. Therapies are chosen based on individual goals, whether they are related to improving communication, mobility, or managing behaviours.
• Assistive technology — Funding can be provided for assistive devices and equipment that help individuals with disabilities to improve their independence and participation. This may include wheelchairs, communication aids, hearing aids, prosthetics, and home modifications. The goal of assistive technology under the NDIS is to increase the participant's ability to perform activities they might otherwise struggle with.
• Home and vehicle modifications — The NDIS may cover modifications to the participant's home or vehicle to enhance accessibility and safety. Examples include ramps, handrails, bathroom modifications, and vehicle hoists. These modifications are crucial for ensuring participants can move freely and safely within their homes and when traveling.
• Community participation — The NDIS supports participation in community activities and social engagement. This can include funding for participation in sports, recreational programs, art classes, social groups, and community events. This support helps reduce isolation and promotes social inclusion for people with disabilities.
• Supported employment — The NDIS offers support for individuals with disabilities to access and maintain employment. This may involve assistance with job training, workplace modifications, and ongoing support to ensure job sustainability. The aim is to help participants find and keep meaningful employment, enhancing their independence and financial stability.
• Respite care — The NDIS can provide funding for respite services, offering temporary relief to families and carers of individuals with disabilities. Respite care is essential for carers to recharge and continue providing support, ensuring the well-being of both the carer and the participant.

What Is Not Covered Under NDIS? 

When considering what is not covered by the NDIS, it’s important to remember that exceptions or specific circumstances where certain items or services are not typically covered may be considered eligible on a case-by-case basis. If a particular support is directly related to your disability and contributes to your NDIS goals, it may be considered even if it's not typically covered.

However, having said this, while the NDIS aims to provide coverage for a wide range of supports and services, there are certain items and services that are generally not covered. Here are a few examples. 

• Mainstream services and supports — The NDIS does not cover supports and services that are the responsibility of other sectors, such as healthcare, education, and income support. These services are considered part of the mainstream system and should be accessed through the relevant government departments. For example, school education and hospital treatments are not covered by the NDIS but by other government programs.
• Medical and healthcare expenses — The NDIS does not cover medical and healthcare expenses that are typically covered by Medicare or private health insurance. However, it may cover certain disability-related healthcare costs that are not covered by these other systems, such as specific therapies or aids directly related to a person’s disability. For example, the NDIS might cover therapeutic supports, but not general medical treatments.
• Day-to-day living expenses — The NDIS does not cover general day-to-day living expenses such as groceries, rent, utility bills, clothing, or general household items. These are considered regular living expenses that all Australians are responsible for managing independently.
• Emergency or crisis supports — The NDIS is not designed to provide emergency or crisis supports. In case of emergencies, individuals should contact the appropriate emergency services, such as ambulance or police. The NDIS focuses on long-term support rather than immediate emergency assistance.
• Recreational or leisure activities without a specific disability-related goal — While the NDIS supports community participation, it generally does not cover recreational or leisure activities that do not have a direct disability-related goal or purpose. For instance, general entertainment activities not related to your NDIS goals would not be funded.
• Supports unrelated to the participant's disability — The NDIS focuses on providing support and services directly related to a participant's disability. Supports that are unrelated to the participant's disability or do not contribute to their overall well-being and functioning may not be covered. This ensures that NDIS resources are directed specifically towards disability-related needs.

How to Apply for NDIS Funding? 

Applying for NDIS funding is simple once you have ascertained whether or not you are eligible. You can either: 

• Call 1800 800 110 and speak to an advisor to make a verbal request.
• Download and complete the Request Form from the NDIS website. 

Once you have requested access, you will be asked to complete an ARF form which can be downloaded and emailed or printed out and sent by standard mail. In addition, local NDIA and Partners in the Community Staff can help you with your application and with later plan management. 

After your application is submitted, it undergoes an assessment process by the NDIA (National Disability Insurance Agency), which may take several weeks. It’s important to gather supporting evidence from healthcare providers as part of this process. Providing detailed evidence can speed up the process and ensure your plan is tailored to your needs.

Once you have successfully received NDIS funding, you can begin to access the services and products of NDIS providers within the remit of your plan. NDIS plans are typically reviewed every 12 months to ensure they continue to meet your needs. During the review, you can adjust your plan to better suit your changing circumstances or goals. For more information on how Medshop can help you find the necessary support equipment you need to improve your quality of life, contact us today. 

Author: Steven John Cumper, B.App.SC. (Osteo.), M.Ost., is a businessman with a strong foundation in biomedical science and osteopathic medicine, who founded and led Medshop to international success, culminating in its acquisition by the Bunzl Group in September 2021, where he continues to serve as Managing Director (Medshop Group).