Diabetes: Is It a Medical Issue or an NDIS Support Need?

Key Points:

• The NDIS does not fund the illness (like diabetes) itself; it funds the permanent disability that the illness causes.
• All clinical management medication, doctor visits, surgery, and dialysis is funded by the general health system (Medicare).
• The NDIS funds the Disability-Related Health Supports, such as a prosthetic limb, or a support worker helping with daily self-care tasks.
• To be eligible for NDIS support, the illness must have caused a permanent and significant impairment that substantially affects your daily life.

Summary:

The NDIS clearly separates its funding role from the health system. While the health system pays for the treatment and medication for conditions like diabetes, the NDIS funds the support required due to the permanent disability that results. For example, the NDIS will not pay for dialysis, but it will pay for the support worker needed to assist with daily tasks that are impossible due to the resulting fatigue. The rule is that the impairment must be permanent and significantly affect your daily functional capacity to be eligible for NDIS support.

Outline:

1. Introduction
2. How Does the NDIS Choose Which Supports It Funds?
3. Can You Get NDIS Support for Diabetes?
4. More Examples
5. How AIIM Choices Can Help You Manage Diabetes-Related Support

The correlation between the NDIS and diabetes is an extremely important and often confusing topic. NDIS is responsible for the consequences of a medical condition, not the condition itself. The distinction is not about the illness, but about the functional impact of the illness on daily life.

How Does the NDIS Choose Which Supports It Funds?

The NDIS is designed to fund disability supports, while the general healthcare system is responsible for funding the diagnosis, treatment, and clinical management of the illness.

The NDIS officially defines its role by funding supports that:

• Relate to a Permanent Impairment: The medical condition, such as diabetes, must have caused a permanent physical, cognitive, intellectual, or sensory impairment.
• Affect Functional Capacity: The permanent impairment must result in a substantially reduced capacity to perform daily activities like mobility, self-care, or communication.
• Are Not Treatments: The support must not be for the clinical treatment of the disease itself, but for the ongoing support needed because of the disability caused by the disease.

The NDIS calls the supports it funds in this area “Disability-Related Health Supports.”

Is Diabetes Covered by the NDIS?

Diabetes is the perfect example of where this line is drawn. You need to know that your medical care stays with Medicare, and your functional support moves to the NDIS.

What is Not Funded Under Your NDIS Plan?

When it comes to NDIS diabetes support, the NDIS will not pay for the core medical management of the condition. This includes things like your insulin, tablets, or prescription costs. It also covers clinical treatment, such as consultations with your GP, endocrinologist, or dietician for general diabetes management. 

What Disability-Related Health Supports are Funded by NDIS?

The NDIS funds the support needed because of the disability caused by diabetes.

For example, the NDIS may fund a support worker to assist a participant who has a severe cognitive impairment and cannot test their own blood sugar or administer insulin safely.

The NDIS may also fund Assistive Technology like a specialised screen reader. If amputation occurs, the NDIS may fund the prosthetic limb and the ongoing physiotherapy needed to teach you how to use the limb and regain mobility.

More Examples

This split applies to many chronic or progressive conditions, illustrating that the funding follows the disability.

Amputation due to Diabetes

If diabetes leads to an amputation, the NDIS steps in to help you live with the physical disability. They will fund your prosthetic limb and the physiotherapy needed to learn how to walk again. They also cover support workers for daily tasks that the amputation makes too hard.

Diabetic Retinopathy (Vision Loss)

If diabetes causes permanent loss of sight, the health system pays for the eye treatments. Through the NDIS diabetes support, you can get the funding you need to manage the blindness. This includes things like Orientation and Mobility training and specialised technology like screen readers for your computer.

Chronic Kidney Disease (Kidney Failure)

Your doctor handles the medical treatments, like dialysis. The NDIS covers the support you need because of the illness’s side effects. For example, they fund a support worker to help with self-care or household tasks when the extreme fatigue from the kidney condition makes those tasks impossible for you.

In short, if the illness has left you with a permanent, ongoing impact that makes daily tasks substantially harder, the NDIS can step in to fund the necessary support to manage that disability.

How AIIM Choices Can Help You Manage Diabetes-Related Support

Managing the daily challenges that come with diabetes-related disabilities can feel complicated, but you don’t have to navigate it alone. At AIIM Choices, our NDIS plan managers can help you understand what supports are claimable under your plan and guide you through accessing funding for the practical assistance you need.

From arranging support workers and accessing assistive technology to coordinating therapy for complications like vision loss or mobility challenges, we work with you to make sure your NDIS funding is used effectively. 

We proudly support NDIS participants across Melbourne, Sydney, Perth, Brisbane, and Darwin, and we’re always just a phone call or email away. 

Reach out to AIIM Choices today to learn how our plan management services can help you get the support you need to maintain independence and improve your quality of life.