The SALT Foundation

What Does NDIS Cover?9 min read

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What Does NDIS Cover?

Information about NDIS funding can be confusing.

Let me give two examples. Firstly, I’ve often heard that children under 7 years old can’t get on the NDIS. Secondly, while researching this post, I found conflicting information about animals. One source said you could get assistance animals funded. Another said you couldn’t.

My goal with this post is to provide you with simple, clear, current and useful information. That way you can make sure the supports you have funded by the NDIS best support your needs.

Guiding Principles Behind NDIS Funding

Decisions about what disability support services will be funded by the NDIS aren’t made willy-nilly. The decision-making process considers several principles.

Supports Delivered Must Be “Reasonable” and “Necessary”

This is the guiding principle behind what supports you can get in your NDIS plan.

Reasonable means, among other things, that the support represents good value. Imagine telling a friend about what you’re using the money for. Would they agree it’s a good use of the money?

Necessary means that without the supports, your impairment limits your life. A life other people take for granted.

NDIS Funding Criteria

The National Disability Insurance Scheme (NDIS), considers several criteria for funding.

Here are their criteria for NDIS supports:

  • Helps you reach your goals and fulfil your aspirations.

  • Helps you take part in social and economic activities.

  • Provides value for money, which can be broken down into two elements:

  • Is the cost similar to or cheaper than alternatives that could provide the same outcome?

  • Does purchasing this support now mean you’re less likely to need supports in the future?

  • Delivers effective and beneficial outcomes for you.

  • Helps you maintain your existing informal supports.

  • Falls within an area NDIS handles.

Supports Not Funded

Just as there are many things the NDIA might include in your NDIS plan, some things will never be funded.

Here is a list of them:

  • Anything where services are delivered by a mainstream (government) service or community services.

  • Something that’s unrelated to your disability.

  • Anything that’s a day-to-day living expense that’s unrelated to your disability.

  • Something that could cause harm to you or anyone else.

  • Anything that makes sense for another service to deliver it, such as the health system.

  • Something that will be used as income replacement.

Pricing Considerations

You may wonder how providers arrive at the fees they charge you under your NDIS plan. The answer to that can be found in the NDIS Pricing Arrangements and Price Limits guide. The guide establishes the maximum fees providers can charge.

For each type of support or service, prices vary depending on the day of the week, the time of day, and your location.

Prices are updated each year, usually on 1 July. Changes take into account factors such as:

  • Market trends.

  • Wage rates.

  • Economic factors such as inflation or the ongoing COVID-19 pandemic.

Pro Tip: It’s especially important for you to know the prices if your NDIS plan is self-managed.

Getting the Supports You Need Funded

When you’ve been accepted as an NDIS participant, you’ll have a planning meeting. In this meeting, you want to make sure you get funded supports to empower you to reach your NDIS goals.

NDIS Budgets

The National Disability Insurance Agency funding falls into one of three budgets.

core supports budget, capacity building budget, capital budget

These are the only budgets from which NDIS funding comes from, so think of this as the big picture view.

Within each NDIS budget are several support categories. We’ll look at these next.

NDIS Support Categories

Support categories are the buckets that collect support items you can get funded. Support items are the specific kinds of support you can get. All support items fall under one of these categories.

This first infographic shows the support items offered under the core supports budget. (We’ve highlighted the services the SALT Foundation provides.)

core support categories and support items

This second infographic shows the support items under the capacity building budget. (Once again, we’ve highlighted the support items the SALT Foundation provides.)

capacity building supports

The SALT Foundation doesn’t provide supports under the capital supports budget. This budget includes items like vehicle modifications, assistive technology and smart devices.

If you need support in a support category we don’t cover, speak to your support coordinator. Alternatively, use the NDIS provider finder.

NDIS in the Time of COVID-19

Like everything else, the NDIS “pivoted” in response to COVID-19. The health system moved to online service delivery unless in-person was essential.

covid-19 changed how your support worker provided support

Now, the pandemic is mostly behind us, but you can still get some COVID-19-specific supports.

If your provider helps with this, they may get the Participation Vaccination Enablement Payment. This payment covers the extra costs involved in getting you vaccinated.

These costs include:

  • Talking through the vaccination options with you.

  • Making appointments and making sure you’re giving your informed consent to getting vaccinated.

  • Arranging COVID-19-safe transport to and from your appointments.

  • Scheduling team members through rostering to provide support.

If you have core funding, another cost you can claim is that of Rapid Antigen Tests (RATs). These are the homes you administer at home to test for COVID-19.

Call the National Disability Insurance Scheme with any questions you have about COVID-19. Call on 1800 800 110. Select the menu option for a COVID-19 and you’ll be put through to a specialist team.

Assistance Animals Through the NDIS

woman with walking sticks out in the community with her guide dog

As I mentioned above, while researching this article I found conflicting information. One website said assistance animals were funded through the NDIS. Another website said the opposite.

So I called the NDIS and found the truth.

To summarise what I learned: The NDIS will fund animals used as disability supports. The criteria is the same for every other support they fund: “Reasonable” and “necessary.”

In most cases, the animal must also pass the Victorian Public Access Test.

Applying for the NDIS

Let’s now look at how to get this funding so you can improve your lifestyle.

Types of Disabilities

The NDIS supports disabilities of the following kinds:

  • Intellectual.

  • Physical.

  • Sensory.

  • Cognitive.

  • Psychosocial.

Eligibility Criteria

In most cases, the standard spiel about the requirements for getting NDIS funding is you must be:

  • An Australian citizen, permanent resident, or be a special category visa holder living in Australia.

  • Aged between 7 and 65. (This is completely wrong. See the pro tip below).

  • Impaired as a result of a disability and thus need support to enjoy the things other people can.

Some disabilities demand that you meet additional eligibility criteria. One example is the extra requirements for psychosocial disabilities.

PRO TIP: The NDIS DOES fund children under 7. The child must have a developmental delay, developmental concern, or disability. At this age, they don’t need a diagnosis. If you have questions, call the NDIS on 1800 800 110.

How to Apply for the NDIS

Applying for the NDIS means you’ll need to do the following.

If you’re eligible, call the National Disability Insurance Agency on 1800 800 110. Make an access request. OR head to your local NDIS office OR complete an online application form.

During the application process, you’ll need to prove three things. Who you are, where you live, and your eligibility.

You’ll be asked to provide evidence of your disability. Such as documents that confirm you have one. How your disability affects your everyday life. Details about past treatments and their outcomes. Proposed future treatments and their outcomes.

Who can provide this evidence? A GP. A pediatrician. A psychologist. An allied health practitioner.

What should the evidence include?

  • The date of your diagnosis.

  • How long your disability will last.

  • Available treatments.

If accepted, you’ll attend a planning meeting to discuss your needs, desires, and goals. To help the planner, take any relevant reports or assessments, as this will help get the right plan for you.

Following that meeting, the NDIS will approve and process your plan. The planner will post or email your plan to you. You’ll become an NDIS participant.

Amount of Funding You Can Receive

You can access many supports through your plan. Services aim to give you what you need to access the same things as everyone else.

Thus, the basis of funding is your “reasonable” and “necessary” needs. You can get whatever amount of funding allows you to do that. There’s no set upper limit.

Annual Reviews

Once a year, your plan comes up for review. When this happens, NDIS makes sure you’re still getting the right supports. Remember “reasonable” and “necessary”? That’s what they’ll use to test your services and supports.

At the SALT Foundation, we have a system in place to make this part of the process easier for you. One of our client team will call you three months before your plan ends. They’ll check on your needs. Based on your answers, they’ll make a report to your support coordinator.

community activities are one reason to celebrate getting on this national scheme

If you need supports to have the same kind of life as other people, and you can’t get what you need from other supports, NDIS funding could be for you.

Here are three takeaways from this article:

  • Principles guide the NDIA’s decisions about who gets funded and how much they get.

  • When applying for the NDIS, make sure you get funding for all the supports you need.

  • If you don’t already have an NDIS plan, check the eligibility criteria, then apply.

Regardless of whether you have a disability, it’s reasonable and necessary for you to take part in life.

What else would you like to know about NDIS funding? Let us know in the comments below.

Further reading: