How do we decide what disability-related health supports we fund?

All NDIS funded supports need to meet the NDIS funding criteria.

Supports we fund need to meet all of the criteria. The following questions are a good starting point to work out if we can fund a disability-related health support:

Do you need the support because of your disability?
Is the support value for money?
Is the support effective and beneficial for you?
Is the support more appropriately funded or provided by the health system or another service?

When we fund disability-related health supports, we’ll also look at what other supports you get through the health system and other mainstream and community supports. Your local area coordinator, early childhood partner, support coordinator or planner will work with you and other services to help you get the support you need.

Do you need the support because of your disability?

Firstly, the support you need to manage your health needs must be because of your disability. The supports we fund should help you to manage or reduce the impact your disability has on your day-to-day life. It 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.

Remember, we don’t fund health and medical services that are already provided through the health system or other specialist health services.

Learn more about services provided through the Australian health system.

Is the support value for money?

When we fund a support it will need to be value for money compared to other options. To make sure the support is value for money we'll look at:

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 or if it will allow you to be more independent and reduce your supports in the future.

Hannah has 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 is not reasonable and necessary to fund a nurse to come each day as well. This is because Hannah’s support worker is able to 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 will do what you need it to do. We also have to consider if 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 take into account your experience. For example, if you’ve used the disability-related health support before and it’s worked for you. Or, how effective the supports have been for other people with similar needs as you.

Is the support more appropriately funded or provided by the health system or another service?

We have to consider if it’s more appropriate for you to get the support from the health system or another service. Some health supports are available to everyone through things like hospitals, dentists and Medicare. We can’t fund it if you can get the support from the health system or another service.

For us to fund it, the support must relate to your disability and you must need it on a regular basis. It should be a repeated or fixed pattern of need. This could be every day, week or month.

Sometimes you won’t need a support on a regular basis, you might only need it once or only for a short time. If this is the case, it’s likely that this is more appropriately provided by the health system or another service.

Learn more about the help you can get through the health system or other services.

Clive falls over and cuts his hand. He goes to the emergency department of his local hospital to get stiches. The hospital tells him to see his local doctor to get the dressing changed every 2 days and the stitches removed after 4 weeks when it will be 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 a reasonable and necessary support because the wound care is the result of a one-off injury. Clive doesn’t need the support on an ongoing and regular basis and the wound isn’t related to his disability. The health system provides all his medical and health care needs for this injury as this was a once-off incident.

Maria had a stroke 5 years ago and is now a NDIS participant. After her stroke Maria needs ongoing and regular support to move around at home and carry out her personal care by herself. She also needs ongoing 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 regular support and exercises to do from a speech pathologist. This helps her to reduce the risk of food or fluids entering her airway when eating, and to maintain her swallowing. We fund these supports for Maria as they relate to her disability, and she needs them on an ongoing and regular basis.

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 was sick and in hospital, she lost 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, as they relate to her recovery from a short-term illness.

Maria completed her 4-week rehabilitation program at home. Her occupational therapist recommended a new support for Maria so she can continue to move around her house and carry out her personal care by herself. We’ll fund this support as Maria now needs it on an ongoing and regular basis so she can move around by herself at home.