This week, we thought we would change tack a little and talk about the National Disability Insurance Scheme, or NDIS. As the name suggests, the NDIS is an insurance scheme that funds supports to people with a permanent disability. The idea is that those supports work to reduce or remove things that disable a person. It is currently helping almost 450,000 people, so it affects a lot of us either directly or indirectly.

The NDIS is still relatively new so we thought we would give a simple description of how the process works. We will look at six steps. Each step has some complexity to it, but the system is not too complex that people cannot access it. In general, the process is as follows.

Step 1

A person provides proof of their eligibility for the NDIS. To be eligible a person must be aged under 65 at the time they commence with the NDIS. There are separate processes for people aged under 7 at the time of commencement, but they can still access the NDIS. A person must also live in Australia and be an Australian resident.

The person must then be disabled as defined by the enabling legislation for the NDIS. There are different ways in which a person can be disabled. Some of the more common are neurological (eg an autism spectrum disorder), psychosocial (a disability arising from mental ill-health), physical or intellectual. It is of course quite common for people to experience multiple forms of disability.

Proof of disability can be provided in several ways, but usually relies on assessments and reports by qualified health or allied health practitioners such as medical doctors, occupational therapists, clinical psychologists etc.

Very importantly, the disability needs to be permanent. While this may make ‘getting on’ the NDIS more difficult at first, it means that step 1 only needs to occur when a person first commences with the NDIS. They do not need to ‘re-prove’ their eligibility for the NDIS each year. People would only need to return to step 1 of the NDIA process at some future time if the nature of their disability worsened and they needed to demonstrate the change in the level of disability.

The process of eligibility for the NDIS is outlined in greater detail on the NDIS website here.

Step 2

Once a person establishes their disability with the NDIS, they meet with a planner to discuss their disability and their goals for overcoming or reducing the disability’s impact. Planners are people who work for the National Disability Insurance Agency (NDIA) which is the agency that administers the NDIS.

In collaboration, the person and the planner identify broad types of services that could be used to meet the person’s goals. Potential services are largely grouped into three categories:

  • Core supports (services which can generally be thought of ‘doing things for’ the disabled person);
  • Capacity Building (services which can generally be thought of developing a disabled person’s own ability to do things); and
  • Capital (which involves things like home modifications, purchases of equipment, etc).

The first two categories each have various sub-categories. For example, within the core category there is a sub-category for ‘assistance with self-care.’ This would be used, for example, if a person needed someone to help them have a shower, or eat, or dress themselves, etc.

Importantly, for the NDIS to fund a ‘support,’ that support needs to be seen as reasonable and necessary. In practice, this means that the NDIS will not fund expenses that non-disabled people also need to meet.

As a simple example, the NDIS will not normally fund a gym membership for a person with a disability. This is because gym membership is an expense that non-disabled people need to pay as well. However, if a disabled person needs to have someone present with them to enable them to use the gym safely, then the NDIS will fund that person. The reasoning here is that non-disabled people do not need to have someone with them while they are in the gym. So, the NDIS funds the expense of making the gym accessible for a disabled person.

Step 3

Once the support needs have been agreed, a funding plan is developed. This is largely an internal process in the NDIA, where the identified needs from the planning meeting are assessed against pre-set rules and guidance to allocate funding.

For core and capacity building supports, the funding is generally calculated by simply identifying how many hours of support will be needed and multiplying this number by the unit price that the NDIS sets for such a support.

For core items, these unit prices usually vary according to the time and day of the week. For example, the current unit price limits for assistance with self-care are:

250 Weekdays x 2 hours x $57.10 per hour = $28,664 Plus
52 Saturdays x 2 hours x $80.10 per hour = $8,330 Plus
52 Sundays x 2 hours x $103.11 per hour = $10,723 Plus
10 Public Holidays x 2 hours x $126.11 per hour = $2,522
Total  = $50,239

 

So, if someone living in a non-remote setting needs two hours of assistance with self-care during the day every day of the year for a whole year, their annual plan would include the following funding:

250 Weekdays x 2 hours x $57.10 per hour = $28,664 Plus
52 Saturdays x 2 hours x $80.10 per hour = $8,330 Plus
52 Sundays x 2 hours x $103.11 per hour = $10,723 Plus
10 Public Holidays x 2 hours x $126.11 per hour = $2,522
Total  = $50,239

 

Therefore, the part of the plan that addresses self-care assistance would have $50,125 allocated to it. This process is then repeated for other core and capacity building assistance.

Capital assistance is a little different. It is usually funded by the disabled person obtaining quotes for a service and submitting these to the NDIS for approval.

Step 4

The plan is then completed and released to the person. The plan will describe the person’s goals and then identify how much funding is available under each of the core, capacity building and capital categories to purchase services to help meet those goals. The plan will be for a set period of time (for example, one year).

A simple way to think about this ‘funding’ is to see the plan as analogous to a series of vouchers which can be used in a restricted range of ways. For example, funding for assistance with self-care can only be used to purchase core services such as a worker to assist with self-care. The money cannot be used to buy a wheelchair, for example. Only money allocated to buy a wheelchair could be used for that purpose.

This is a really interesting and neat element of the NDIS design. Until a person ‘presents their voucher’ (ie actually engages a support), the NDIS does not need to pay anything. As it happens, people typically only actually use on average 68% of the funding available to them via their plan. The ‘unspent’ 32% remains with the Commonwealth.

Step 5

The plan is then implemented. There are various ways that a plan can be implemented, which we do not need to go into here. It is important to note that the extent to which people control the implementation of their own plan depends on the person. Some people ‘self-manage’ some or all of their NDIS plan. This can include having a nominee such as a parent manage the plan for them. Others engage professional providers to assist them to implement the plan.

Step 6

At the end of the plan period, the plan is reviewed and a new plan is developed. This essentially means a return to step 2 above, with steps 3-6 following.

The exception here is where a person’s disability has changed. If that happens, they can request that their plan be reviewed at any time and the process recommences from step 1 above, with step 1 in this case simply being the person demonstrating the change in the disability.

Other Things to Remember

As of March 31 2021, there were almost 450,000 people across Australia with an active NDIS plan. While there is a lot of variation, the average plan provided $70,000 of funding. Of this, on average 68% of the funding was actually being spent. This is $47,600 per person on average.

The NDIS is not means tested. That means that your income or assets are not assessed when considering your eligibility for the NDIS.

People need to commence with the NDIS before they turn 65. If they have not started before that age, then they need to use the aged care system for financial assistance.  People who commence with the NDIS and then turn 65 can usually choose whether to continue to use the NDIS or to move to the aged care system – although they usually can only access funding from one or the other system.

If you or someone you know may be eligible for the NDIS, the best thing to do is to contact the NDIS on 1800 800 110. If you are not sure what to do, give us a call and we can help you get started.