Can it be funded by my NDIS plan?
Updated: Oct 18, 2021
We have all heard about the wild claims that someone purchased a yacht and that funding a sex worker is going to send the scheme broke. But what's the truth about what can and can't be funded?
This is a question that arises for every participant and while there are a few definite rules, there are also some ambiguous guidelines that don't provide many clear answers. Let's break it down to a few simple concepts to work within.
What is likely to be funded by NDIS ...
A simple summary of the criteria used by the National Disability Insurance Agency to develop a participant's funding plan is to ask if the item is "reasonable and necessary". We can understand this term better by questioning if the item of support is:
related to the participant's disability,
not a day-to-day living expense,
value for money compared to other types of support,
likely to be effective and beneficial,
will assist with individual goals, social or economic participation
it will help to maintain informal supports
is not a support best delivered by family, carers, the community, or other government services
What is definitely, almost certainly, and sometimes questionably, NOT able to be funded …
As a general rule the following things usually (but there's always some exceptions) cannot be funded by NDIS because they are considered everyday living expenses:
Accommodation - mortgage or rent
Daily living expenses - groceries, food, clothing, hairdressing, beauty therapy
Utilities - phone, electricity, gas, water, internet etc
Recreation and entertainment - holidays, tours, sport, cultural activities, hobbies
Illegal or likely to cause harm
The following are usually funded or delivered by other government agencies or community services:
Education - State governments are responsible for primary and secondary schooling while tertiary education is funded by the Commonwealth
Health (where it doesn't relate to a disability) - Medical and dental care is usually funded by the health system via Medicare or private health funds
Other government funded services - e.g. Aged care, child care, social welfare, drug and alcohol services, homelessness, industrial relations, and emergency services
Community services such as drop-in centres, libraries, advocacy, unions
And then we have the maybe, possibly, and 'depends how you word it' categories ...
There are always exceptions to the rules (some are noted above) and the NDIA are constantly reviewing guidelines or responding to directions from tribunal and court rulings. We need to note that a ruling by the Administrative Appeals Tribunal (AAT), or a higher court, generally does not mean a blanket change for everyone as they are usually only applicable to the specific circumstances of the individual participant in that case. AAT decision summaries are published here.
So, who makes the decisions?
In the first instance a participant has control of their funding and is the best person to know whether an item of support is appropriate for their needs. Participants can work with their Support Coordinator, Plan Manager, or allied health team to get the best advice on whether a support is likely to meet the guidelines.
No service provider has the right to decide if a support can be funded, however a registered provider must ensure that they only claim for a good or service within the published guidelines. This means that a Plan Manager may decline to process an invoice for a questionable support.
The NDIA have published a Would We Fund It guide to assist participants understand the criteria and assist in this decision making process. Additionally, there's also a simple guide available on page 11 of Participant Booklet 3 - Using Your Plan.
If a participant disagrees with a service provider, Plan Manager, or a decision made by the NDIA regarding a support they can follow the relevant procedure for making a complaint or appealing the decision.
if you have any questions, please drop a message to us and we'll be happy to assist.