We hear this question all the time. Working out what the NDIS funds and what it doesn’t can be very difficult.
A comprehensive list can be found in the NDIS Price Guide, but it’s a beast of a document.
In this blog, we’ll make things simple by outlining a rule of thumb to help you work out if the NDIS might fund it.
But before we start, if you have a question that is health related, you might want to check out our blog the NDIS and the health care system – who funds what?
It all comes down to what’s reasonable and necessary, but what does that even mean?
Anyone transitioning to the NDIS will probably be well-acquainted with the phrase “reasonable and necessary”. But what does this actually mean?
Reasonable is something that is fair.
Necessary is something you have to have because of your disability.
The NDIS funds “reasonable and necessary supports” relating to a person’s disability to help them live an ordinary life and achieve their goals.
When you attend your planning meeting, the NDIA Planner will gather information on which supports are reasonable and necessary to your situation. When your planner is assessing what is reasonable and necessary, they will be evaluating whether a support request is:
- related to your disability
- not a day-to-day living cost that is unrelated to your disability support needs
- value for money
- likely to be effective and beneficial to you.
They will also take into account the unpaid, informal supports provided to you by family, carers, networks, and the community.
What may be considered unreasonable for one person may in fact be considered to be quite reasonable for someone else with different support needs.
Don’t assume the Planner fully understands the needs of you or your family member. Be prepared to talk about why a request should deemed to be ‘fair and reasonable’.
The golden question
The NDIS exists to close the gap between having a disability and not having a disability.
Ask yourself – would someone without a disability be expected to pay for this?
If the answer is ‘yes’, then chances are it is a mainstream cost. Things like food, holidays and vehicles are considered mainstream costs. Even though people with a disability often need or use these things, they are not disability specific and therefore unlikely to be covered by the NDIS.
Below you’ll see an example of the difference between a mainstream cost and something that the NDIS might cover.
Examples of supports
Here are some examples of supports that are often deemed reasonable and necessary:
- Support workers to help with personal care activities
- Therapeutic supports like occupational therapy, speech therapy and behaviour support
- Aids and equipment
- Home modifications
- Mobility equipment
It’s worth noting here that this is not a comprehensive list. While these are commonly funded, every plan is different and your funding will always be based on individual circumstances.
In an example
Tim has an intellectual disability and one of his NDIS goals was to attend more football games.
Tim would need to use his own money to buy the things that someone without a disability would generally pay for. In this example, this would be things like:
- The entrance ticket to the game
- A pie
- A drink
- A jersey to wear
The NDIS however could fund things that would help Tim overcome any barriers that arise from his disability. This could include:
- A support worker to support him to attend the game
- Specialised transport in line with his mobility needs (if applicable)
But who is buying the ticket for the support worker?
Tim would have to pay for that ticket too (unless the football club accepts Tim’s companion card and allows the support worker to attend for free)