We can only include NDIS supports in your plan if they meet all the NDIS funding criteria .
The following questions are a good starting point to work out if we can fund a disability-related health support:
When we think about what NDIS supports to include in your plan, we’ll also look at what other supports you get through the health system and other mainstream and community supports . Your my NDIS contact, support coordinator or recovery coach will work with you and other services to help you get the support you need.
Once we’ve identified the supports and decided they meet the NDIS funding criteria , we’ll include the description and funding for the NDIS support in your plan.
Learn more about how we include the reasonable and necessary supports in your plan .
Is the support related to your disability?
We’ll only fund disability-related health supports if you need them because your disability:
causes the health condition, or
you need help to manage the health condition.
The NDIS supports we fund should help you to manage or reduce the impact your disability has on your day-to-day life. They should help you be more independent and do things like see your friends or go to work.
You can ask yourself, ‘If I didn’t have my disability, would I need this health support?’
If the answer is ‘No’, then it’s probably disability related.
If the answer is ‘Yes, I would need this even if I didn’t have a disability’, then it’s unlikely to be disability related.
Example
Clive falls over and cuts his hand. He goes to the emergency department of his local hospital to get stitches. The hospital tells him to see his local doctor to get the dressing changed. This must be done every 2 days, and the stitches need to be removed after 4 weeks when it is fully healed.
Clive wants the NDIS to fund a nurse to come to his home to change the dressing and remove the stitches. This is not an NDIS support because the wound care is not related to Clive’s disability. The health system will provide for all medical and health care needs for this injury.
Example
Maria had a stroke 5 years ago and is now an NDIS participant. Maria needs support to move around at home and carry out her personal care by herself. She also needs support from a speech pathologist so she can swallow and eat safely.
Maria uses a walking stick, grab rails or chair arms to move around at home by herself. She uses a shower chair to shower and dress by herself. She also gets support and exercises to do from a speech pathologist. This helps her reduce the risk of food or fluids entering her airway when eating and helps her maintain her swallowing. We fund these supports for Maria because they are NDIS supports that relate to her disability.
Maria then becomes unwell with an infection in her lungs. She goes into hospital for 3 weeks for treatment. Maria recovers from the infection. But while she is sick and in hospital, she loses some of her ability to move around, shower and care for herself.
After hospital, Maria moves to her local rehabilitation service to get physiotherapy and occupational therapy for 2 weeks. The rehabilitation service helps Maria to move around and care for herself again. After her stay at the rehabilitation service, Maria goes home and has visits from her community health rehabilitation service for another 4 weeks. These services are provided by Maria’s local health system. After Maria’s 4-week rehabilitation at home, her occupational therapist recommends a new support so she can continue to move around her house and carry out her personal care by herself. We’ll fund this support as it’s an NDIS support related to her disability.
Is the support value for money?
All supports we fund under the NDIS need to be value for money. This means the cost of the support is reasonable when we consider the benefits of the support and the cost of other supports.
When we decide if a support is value for money, we think about:
whether it’s cheaper to buy or rent the equipment
who is the most appropriate person to deliver the support, for example a family member, support worker or nurse
whether there is another lower-cost support that would get the same result.
We’ll also look at whether the support will benefit you in the long-term. We’ll also look at if it will allow you to be more independent and reduce your supports in the future.
Example
Hannah is 28 years old and lives with Down syndrome and diabetes. She needs to test her blood sugar level daily with a finger prick test but due to her disability, she is unable to do this herself.
She is about to move into her own home and will have some help each day from a support worker.
Hannah would like her support worker to be able to help her safely test her blood sugar level. Hannah has funding included in her plan so that her support worker can be trained to safely test her blood sugar level instead of a nurse.
This is value for money because Hannah’s support worker is already visiting each day. It isn’t reasonable and necessary to fund a nurse to come each day as well. This is because Hannah’s support worker can safely help with testing Hannah’s blood sugar level.
Is the support effective and beneficial for you?
We have to make sure the disability-related health support is effective. This means it’ll do what you need it to do. We also have to think about whether it’s beneficial. This means it will work and make things better for you, or it will help you do more things by yourself.
We also think about your experience. For example, we look at whether you’ve used the disability-related health support before and how it worked for you in the past. Or, how effective the supports have been for other people with similar needs to you.
Learn more about reasonable and necessary supports .