Understanding your NDIS Funding
The NDIS allows you to have as much choice and control as possible over the supports funded or provided in your NDIS plan but there is a key phrase to remember when considering what supports and services your funding will pay for.
“Reasonable and Necessary” is the criteria used to determine whether services and supports can be funded or not.
But what does this phrase actually mean? Let's break it down.
When talking about reasonable and necessary supports, the NDIS are asking;
Is the Support related to your disability?
The NDIS can’t fund a support if it’s not related to your disability. This means there must be a direct link or a connection between your disability and the supports the NDIS funds.
The NDIS looks at whether the support addresses your disability support needs. Your disability support needs are those that arise from, or are caused by, your disability.
Is the Support value for money?
All supports funded under the NDIS need to be value for money. This means the cost of the support is reasonable, when the NDIS consider the benefits of the support and the cost of other supports.
Making sure that your supports are value for money is one of the ways the NDIS remains financially sustainable. This means the NDIS make careful decisions about funding to make sure the NDIS exists for future generations.
Is the Support Effective & Beneficial?
The NDIS need to be satisfied that the support will be, or is likely to be, effective and beneficial, when they consider current good practice.
The NDIS need to work out if the support is likely to be both:
• effective – it will do what you need it to do
• beneficial – the support will help you do things you can’t otherwise do and meets your support needs.
Is the Support something the NDIS would reasonably expect your informal supports to provide?
The NDIS need to be satisfied that funding the support takes into account what is reasonable to expect families, carers, informal networks and the community to provide.
To make sure they understand how disability supports might work for you, they consider:
• the things you’re able to do for yourself
• any support you have from others in your network – including family members, relatives, friends and local community services.
Does the Support help you to pursue your goals?
The NDIS need to be satisfied that the support will help you pursue the goals, objectives and aspirations in your NDIS plan. This helps them determine if the support is necessary.
While the NDIS only fund supports that help you pursue your goals, objectives and aspirations, they understand that different people express themselves in different ways.
You are free to choose your own goals and express them in your own words.
Your goals can be big or small, short term or long term, simple or complex. They can be about anything you want to work towards.
You may express your goals broadly, or you may have specific goals. For example, you may express one of your goals as ‘living independently’. Someone else may express their goal as ‘to have an accessible bathroom’.
Does the support help you do activities that will help your social and economic participation?
The NDIS need to be satisfied that the support will help you to do activities, which make it easier for you to participate socially and economically.
Social participation means doing things you enjoy, like going out with friends, playing sport or going on holiday. It also means doing the things you need to do, like going to school or medical appointments.
Economic participation usually means being involved in things that help you work towards getting and keeping a job. This might be things like volunteering, study, learning new skills or trying work experience. Research tells us that work can lead to health benefits and improve our quality of life.
So what else do you need to know about working out if your supports fit the criteria?
There are a few common misunderstandings about how the NDIS works out what supports meet funding criteria.
Why don’t the NDIS always fund what your health professionals recommend?
Although they take expert opinions into account, they can’t and don’t always fund everything your health professional might recommend. This is because every support they fund needs to meet all the NDIS funding criteria.
For example, your therapist might recommend a piece of equipment on the basis that it will be ‘effective and beneficial’ for you. But if there is something cheaper that will achieve the same outcome, the NDIS won’t be able to fund what the therapist recommended.
This is because it won’t be value for money. They may be able to fund the cheaper option instead if it meets all the NDIS funding criteria.
Why don’t the NDIS fund the same supports as your last plan?
They might fund different supports in your next plan. This is because they will fund supports in your plan based on how they use the NDIS funding criteria at that point in time.
Your needs and situation will most likely change over time. This means it’s likely your NDIS supports and funding for those supports will change over time.
For example, they may have funded supports to help you build your skills in a particular area. Once you have built those skills, you won’t need funding for that any more. So, the NDIS probably won’t include that funding for those supports in your next plan.
Supports to build your skills may have met the NDIS funding criteria before, but the same supports might not meet the criteria in future.
Or, your disability support needs might increase or decrease over time. This may mean the NDIS consider funding more or less supports as a result.
The NDIS really do take an individual approach to funding by considering your unique circumstances, needs and goals. Remember that the NDIS is there to help you achieve the best possible outcomes based on your individual situation which is why it's important to be open and honest during your discussions with NDIS planners and Local Area Coordinators and clearly explain your needs.
For any more information about NDIS Funding Criteria, you can head to the website here.
