As an NDIS-eligible participant, it is crucial to have a full understanding of NDIS-supported activities and excluded ones. While the scheme aims to foster independence, community participation, and overall well-being for its participants, support activities come with limitations as well — particularly under the “reasonable and necessary” categories.
Certain services and supports are not supported by the NDIS funding often because this is the responsibility of another government agency, it might not be related to the disability needs of the participant, or it poses a threat to public safety.
Some examples of these activities and expenses excluded from the NDIS funding are:
- Day-to-day living cost
- Medical services
- Some transportation
- Supports considered harmful or unsafe
- Support not related to disability
- Duplicate services
With a comprehensive understanding of the services covered and not covered by the NDIS, participants can actively shape their NDIS experience and optimise their funding. In this post, we aim to assist participants in their decision-making process by shedding light on the types of support usually not included in an NDIS plan.
What is NDIS?
The National Disability Insurance Scheme (NDIS) is a program created by the Australian government to provide assistance and support to its eligible citizens and persons with disabilities, through access to financial support, inclusive community spaces, and opportunities that can help them in their professional and personal growth. This then leads to improved quality of life for the participants and their loved ones, as well as their independence and sense of belonging and contribution within the community.
What are the NDIS-funded activities?
While the NDIS Plan covers a broad range of services, its supported activities must be based on the “reasonable and necessary” needs of the participants, together with support from family, friends, community members, and the government. These are divided into three (3) main categories:
- Core activities such as consumables to aid in improving quality of life, daily activities necessary for self-care, assistance in community participation, and transport.
- Capacity building includes choice and control of activities, employment, therapy that can help in community participation, home living, behavioural support strategies, and a range of other therapeutic activities to help the individuals
- Capital support is further divided into (1) assistive technology for self-care, mobility, and communication, to name a few, as well as (2) home modifications such as the installation of accessibility ramps and handrails.
More information about services covered by the NDIS fund can be found here https://www.ndis.gov.au/understanding/supports-funded-ndis
What are the services not supported by the NDIS fund?
As mentioned, while the NDIS provides a range of support and services for people with disabilities, aiming to improve their quality of life and help them achieve their goals, not everything is covered by an NDIS plan. Some services or supports may not be included in an NDIS plan because they do not meet the NDIS criteria of being “reasonable and necessary.”
Below is a brief overview of some of the services and supports typically not covered by an NDIS plan:
Day-to-Day Living Costs
It’s crucial to understand that NDIS funding is not intended to cover typical day-to-day living expenses. These regular costs, like rent or mortgage payments, groceries, utility bills, clothing, and general recreational activities, are unrelated to a participant’s disability and are expenses that everyone has, regardless of disability.
The reason for this exclusion is that the NDIS is designed to provide additional support specifically related to a person’s disability, rather than covering routine expenses. However, it’s important to note that certain additional costs arising from a participant’s disability, such as special dietary needs or adaptive clothing, may potentially be covered under an NDIS plan.
The NDIS does not typically cover medical services like medical treatments, medications, surgeries, or hospital costs. These aspects are generally provided by Australia’s universal health care system, Medicare.
The NDIS and Medicare work together, with Medicare handling medical and hospital expenses while the NDIS focuses on funding supports to help participants manage their disability in their day-to-day lives.
The NDIS provides support for individuals in their educational journey by funding disability-related aids and personal assistance. However, it does not cover school or course fees as the responsibility for education services lies with education departments, not the NDIS. This also falls under services that are necessary for an individual, whether they live with specific needs or not.
Nevertheless, certain supports like assistive technology for learning or personal care during school hours may be funded under an NDIS plan.
Typically, the NDIS does not cover regular transport costs, including expenses like petrol, car maintenance, registration, and insurance. However, if a participant’s disability significantly increases these transportation costs, the NDIS may offer financial support. For example, specialised transport required for school or work due to a participant’s disability may be funded by the NDIS.
Supports Considered Harmful or Unsafe
The NDIS will not fund any supports or services deemed to be harmful, risky, or unsafe for the participant or others. This exclusion ensures the protection of NDIS participants and upholds the scheme’s core principle of safeguarding and promoting the well-being of people with disabilities.
Supports Not Related to Disability
If a support or service is not directly related to the participant’s disability or does not aid in achieving their specific goals, it is typically not funded by the NDIS. The scheme is specifically designed to fund supports that cater to an individual’s disability-related needs and assist them in achieving their ambitions.
The NDIS will not fund supports that are already funded or provided by another government department or agency. For instance, if educational or health services are being funded by respective departments, the NDIS will not duplicate these funds.
In conclusion, while the NDIS provides substantial support to individuals with disabilities, it’s essential to note the areas it doesn’t cover. Always consult with an NDIS representative or a knowledgeable plan manager for the most accurate and personalised advice.
Choose AIMM Choices
Navigating all the NDIS rules about what is or is not funded can be difficult. It does depend on what is stated in your plan. AIIM Choices is a leading NDIS plan management service provider and has extensive expertise in helping participants to get the most from their plans. We work with you at your pace to understand you plan. We can provide free advice when it comes to funding rules and work with you to find a way forward. The way we work is to be part of your support team, we’re here to help.
Our commitment is to provide participants with dedicated NDIS fund managers tailored to their unique needs. With a team that communicates in 15 languages and an app designed to help in fund management, we are happy to be able to support more NDIS participants in maximising their NDIS funds.
Reach out to us today, and discover how we can assist you in managing your NDIS fund and optimising your plan for maximum benefits with NDIS-funded activities. Let us help you make the most of your NDIS journey. Contact AIIM Choices today!