If you’ve ever had a copy of your NDIS plan and found yourself baffled by how it’s written, you’re not alone. The core supports, plan management, and reasonable and necessary terms can leave the most organised families scratching their heads.
But there’s something truly transformational going on beneath the jargon – funds saved to help anyone with a disability find ways to make skills, connection and a life on their own terms a reality.
This guide will take you through the process of NDIS funding in Australia, who is eligible, what it pays for and strategies to maximise funding. If you’re a first-time applicant or providing care for a family member, without a plan review or planning to review a plan yourself, you’ll come out with a clear path forward.
The Scheme Behind the Dollars: What the NDIS Really Is
is an excellent resource for understanding the NDIS. The National Disability Insurance Scheme (NDIS) is an Australian Government initiative overseen by the National Disability Insurance Agency (NDIA), that offers funding for some supports and services to individuals with a permanent and significant disability.
It was released as trial sites in 2013 and is now being rolled out nationally, with a unified approach.
“Choice and control is the big idea.”
Rather than targeted towards a particular service, an individual budget is set, and participants can choose within the rules of the budget how that money is spent and who provides their services.
The national rules are the same for Perth, Parramatta or Port Augusta, but these can be vastly different in terms of the providers available.
Are You In? It Doesn’t Need to Be Complex, Just Easy to Understand.
In order to gain access to the scheme, in the majority of cases it is required to:
- When the application is made, be less than 65 years of age.
- Have lived in Australia as an Australian Citizen, permanent resident or Protected Special Category Visa holder
- Meet the disability criteria or the early intervention criteria.
The disability criterion applies if you have some permanent condition that significantly affects your ability to participate in daily activities, or to live a normal life without assistance.
The early help provision applies in circumstances where access to help at this time is likely to lead to fewer help needs subsequently, e.g. children with developmental delay.
The difference between an application and an approval is evidence. Letters from your GP, specialists, psychologists, occupational therapists and/or other health professionals demonstrate the impact of your disability on your everyday life.
The best evidence is recent, specific and concerning not just your diagnosis but what is and isn’t permitted.
Your Budget Is Organised into Three Buckets, One Plan.
Having been approved, the NDIS will help you to create a plan that outlines what you want to achieve and what supports will help you get there.
There are three types of support in a plan, and it is important to understand these to use NDIS funding to the best of your ability.
1. Core Supports
Core Supports refer to supports used for basic activities that can be done at home, in the community and for personal care, household-related and transport needs.
Typically, the most flexible budget is this one, and you may be able to transfer money to or from other categories.
2. Capacity Building Supports
Capacity building supports are about building skills and independence. Consider – support organisations, therapy facilities, employment supports and assistance with day-to-day living.
Normally speaking, these funds are restricted to their designated category and can not be transferred to other locations.
3. Capital Supports
Capital Supports will be responsible for large one-off payments like assistive technology, vehicle modifications, specialist disability accommodation and home modifications.
They would normally only be granted when there are indications of need by assessments or quotations.
Consider 2 Words That Govern Every Decision: Reasonable – Necessary.
All supports in your plan need to meet a reasonable and necessary criterion outlined in the NDIS Act.
Here’s, in layman’s terms, what a support has to do:
- Be directly related to your disability.
- Support you in yourself to achieve your goal and participate in social and economic life
- Understand and apply unit rates.
- Be effective and likely to benefit you
- Be something funded by the NDIS, not health, education, housing or another government system
For this reason, the NDIS does not usually cover rent, groceries or bills that you have to pay in your typical day-to-day life, and treatment of the medical issues is in the health system.
When a Request is rejected, it is almost always as a result of one of these criteria not being clearly portrayed. It’s not a greater argument, usually better evidence.
Who’s Money Do You Carry? There Are 3 Ways to Manage Your Plan.
The way your plan is administered will dictate the extent of your freedom, and the amount of paper you get.
1. NDIA-Managed
When these providers receive monetary payments from NDIA, it is paid directly to you, as the provider does not receive the money. Simple draw; only works with those that have been registered by the NDIS.
2. Plan-Managed
You have a registered plan manager who pays your bills and monitors your plan. Uses registered and unregistered providers, and management of plans is normally funded away from your support budgets.
3. Self-Managed
You pay the providers, then claim the cost back. This offers you the most choice about which providers to select, but also obligates you to retain the records.
Many participants combine treatments and plan managers for support workers – that is, self-managed therapy – for instance.
Implementation Plan Approval Process: The Roadmap
1. Check Your Eligibility.
Complete the checklist found on the NDIS website (ndis.gov.au) or contact the NDIA (1800 800 110).
2. Fill Out an Access Request.
This can be based on the guidance of a Local Area Coordinator or the Early Childhood Partner, and evidence can be attached.
3. Don’t Overreact to the Decisions to Access.
The NDIA might request additional information; be quick to respond to keep things moving.
4. Do Some Homework for Planning.
Write down a typical day in your life, your greatest difficulties, your aims, and supports you are currently using. Where possible, include quotes/reports.
5. Get and Start Your Plan.
After receiving acceptance, determine how to deal with it, meet suppliers and sign contracts.
6. Prepare for Review.
Plans are updated regularly, and progress reports and receipts are compiled along the way.
Stretching The Budget Without Stretching Yourself – Confident Plan Holders
Understanding how to implement good habits can result in turning the NDIS funding from a number on a screen into real outcomes.
Some that always deliver:
- Monitor and review your account balances frequently. Check the myNDIS portal, app or reports through your plan manager to know how much has been spent and how much is left in your plan.
- Compare providers. Before signing a service agreement, inquire about fees, travel charges, and cancellation provisions and waiting times.
- Book early. There is sometimes a waiting list for therapy and specialist services, particularly in non-capital cities, and a budget with no expenditure through the review period could equate to a lack of need.
- Keep records. Invoices, receipts, progress notes and therapy reports are gold when your plan comes up for review.
- Consider support coordination. If finding providers is too difficult, a support coordinator will do the ‘heavy lifting’ for you.
Different Results in Different Areas: Funding Across Australia.
The rules are of the nation; the experience is not.
You might have a great deal of choices of therapists and support workers in Sydney, Melbourne and Brisbane. Services may be less dense in the further reaches of regional Queensland, rural Victoria, the NT or remote WA, with longer wait times for services.
The NDIS pricing arrangements allow for loading (extra costs) to be charged for the additional support needed to deliver services that are based in remote and very remote areas and many providers do deliver services via telehealth in order to cover the distance.
If outside a large city, begin your research early and discuss with your Local Area Coordinator what is available locally and sound in terms of travel charges.
When the Answer Is No: Reviews, Appeals and Your Rights
It’s not necessarily the end of the line to be disappointed with a decision.
If you do not feel the access decision or plan decision is right for you, you may request an internal review of the decision (usually within 3 months of the decision) with the NDIA.
If still not satisfied with the result, you can again appeal to the Administrative Review Tribunal, which has taken the place of the Administrative Appeals Tribunal in this area.
There are elements of free, independent disability advocacy support to help prepare, so don’t feel the assistance needs to be grim solo.
Requesting a review indicates that there is dissatisfaction with either the criteria or the documentation provided. Be sure to indicate what specific aspects you are disagreeing with, include any additional documentation or report(s), and reference back to the reasonable and necessary criteria.
The Bottom Line
“Your Plan isn’t a test, it’s a tool.
A plan isn’t a sentence or the end of your life or a limit on your goals. It’s a toolkit that is best when you know what each tool does.
If you have an understanding of eligibility, the 3 types of budgets, the reasonable and necessary test and your management options, then it will no longer feel like a maze and, instead, feel like a map.
Our friendly staff members can assist you in preparing evidence if you need a hand, and know of your budget as well as trusted providers in the region.
Contact us now and take the next bold step towards the life you desire.
FAQ’s
What is NDIS funding?
Money allocated in a participant’s NDIS plan to fund disability supports and services.
Divided into three distinct budgets (core, capacity building and capital) it is funded by the Australian Government via the National Disability Insurance Agency (NDIA) and can be used to help reach a particular goal with more independence and choice.
So, Who Qualifies for the NDIS in Australia?
For most applicants, they must be under 65 years of age and be an Australian citizen, permanent Australian resident or have a Protected Special Category Visa for Australia and be either disabled or meet the early intervention criteria.
Mostly, there needs to be some evidence of health professional attestation to the effect on daily living along with the application.
What is the Maximum Benefit a Person Can Get on the NDIS?
There is no definite amount. Every budget is unique to an individual and depends on the supports the NDIA feels are reasonable and necessary for their disability, goals and circumstances.
People with complex high-level support needs might have budgets of a few thousand to several hundred thousand a year.
What is Funded, and Not Funded by the NDIS?
The NDIS may be able to provide funding for disability supports, including: personal care, therapy, assistive technology, support coordination and community-based and/or home modifications.
In a nutshell, it is not intended to support usual adult living expenses, such as rent or food, or medical care, or anything unrelated to your disability support.
Where Do I Get Funding Through the NDIS?
The first step is to complete an Access Request; this can be done via a Local Area Coordinator, Early Childhood Partner or by calling the NDIA on 1800 800 110. Add details about your disability. A planning conversation will take place if you are eligible, before finalising your plan.
What Do Plan-Managed, Self-Managed and NDIA-Managed Plans Mean?
For the NDIA-managed plans, the NDIA make payments to the registered provider. Plan-managed plans allow a plan manager to pay the invoices, and the use of registered or unregistered providers is allowed. Self-managed plans are where providers charge you, and then you are reimbursed, and it is the most paperwork & the most control.
How I Can Take Action if My NDIS Plan Is Underfunded, or if a Request Is Rejected?
You can request an internal review from the NDIA within 3 months of the decision, referencing new evidence of relevant connection to the supports and your goals, and the reasonable and necessary requirements. If the outcome is the same, then you may apply to the Administrative Review Tribunal. Free advocacy services can be helpful, and a plan can be reassessed if circumstances change.
