Who funds it? Knowing where to turn for the supports you need

‘Will they fund it?’. When it comes to the National Disability Insurance Scheme (NDIS), this is the number one question we get asked every day.

The NDIS has a lot of information to unpack, including what supports a plan may cover and what it doesn’t fund – information that’s critical to providing you with the confidence and certainty you need to use your plan.

In this article, we look at the NDIS and the Australian health system to explain which supports sit under each, and what the NDIS doesn’t fund.

The Australian health system

The Australian health system is designed to assess, diagnose and treat chronic and ongoing health conditions.

It’s responsible for services that directly relate to a person’s health status, treatment and health interventions, like:

• Treatment from a General Practitioner (GP), medical specialist or dentist
• Care in hospital
• Medications and pharmaceuticals
• Rehabilitation and support after a recent medical or surgical event

Medicare, Australia’s universal health care system, covers the cost of some medical services.

The NDIS

The NDIS provides funding to support eligible people with disability to increase their independence, spend more time with family and friends, pursue social activities, learn new skills, access jobs or volunteering opportunities in their community, and improve their quality of life. It also connects people with disability to services in their community.

The NDIS covers the cost of supports to help a participant undertake activities of daily living – like permanent aids and equipment, personal care, domestic assistance, and community access.

Here’s a list of what the NDIS can fund (if it’s reasonable and necessary for a participant):

• Aids like wheelchairs, hearing aids and adjustable beds
• Items like prosthetics and artificial limbs (not surgery)
• Home modifications, personal care and domestic assistance that helps participants exiting the health system to live independently
• Therapies needed as a result of impairment, including physiotherapy, speech therapy or occupational therapy (not treatments)

What the NDIS doesn’t fund

These services sit inside the Australian health system and are not funded by the NDIS:

• Clinical services and treatment of health conditions
• Medications and pharmaceuticals
• Sub-acute services like palliative, geriatric and psychogeriatric care
• Post-acute care services, including nursing care for treating health conditions and wound management
• Dental care and all dental treatments
• Medical and clinical services where individuals and families have a role in funding

If you seek these services and feel they are directly related to your disability, you should speak to your National Disability Insurance Agency delegate (planner/local area coordinator) about approval of similar supports covered by the NDIS. For example, pharmaceuticals are sometimes approved by planners.

We’re here to help

Understanding what an NDIS plan can cover is a sticking point for a lot of participants, whether or not they’re new to the Scheme. That’s why we have a dedicated team of NDIS experts on hand to advise you about the supports, services and providers you can access through the NDIS.

This article – ‘How you can spend your NDIS funding – everything you need to know’ – will help you to get started.

We can also help you to find the right providers and, if ever you happen to run out of funding in one category, we can show you the different categories you may be able to claim from.

To connect with our team of NDIS experts about what you plan can cover, you can call us on 1800 861 272 from 8am-6pm (SA time), Monday to Friday, or email us at [email protected].

If you’re not currently a My Plan Manager client and you’d like the support of Australia’s largest (and leading!) plan management service, click here.