Case example
Huan has limited mobility due to his disability. He needs specialised footwear to manage pain, help improve his gait and limit the likelihood of making the effects of his disability worse.
Would we fund this?
Yes, we would typically fund specialised footwear and customised orthotics for Huan, as they are NDIS supports which are likely to meet the reasonable and necessary criteria. We would need evidence to support Huan’s request. This could be a report, letter or email from his therapist or podiatrist.
Why would we fund this?
We fund NDIS supports. NDIS laws determine what we can and can’t fund. Things we can fund are called NDIS supports. You can use the funding in your plan to buy NDIS supports if they are related to your disability and are in-line with your plan.
Clothing and footwear are considered an everyday living cost that’s not due to a person’s disability support needs. This means they’re not NDIS supports. However, we recognise Huan may need specialised footwear and custom orthotics as a result of his disability. In this case, they’re an additional living cost that is related to his disability support needs, and we may fund them.
To work out whether specialised footwear and customised orthotics are reasonable and necessary for Huan, we’d look at the information he provided and compare it to reasonable and necessary criteria.
We’d need evidence, such as written evidence from a therapist or podiatrist, to show how the specialised footwear and customised orthotics:
- are NDIS support that relate to Huan’s disability support needs
- will help Huan pursue the goals in his plan and undertake activities to help his social and economic participation
- will be, or is likely to be, effective and beneficial for Huan, having regard to current good practice
- represent value for money, for example evidence that the support is fit for purpose and would likely reduce the long-term cost of other supports with orthotics.
What else do we think about?
We don’t fund specialised footwear for injuries, for example a broken toe, or to treat a health condition. This is because it’s more appropriately funded by the health system.
We won’t fund extra items that don’t relate to Huan’s disability. He may choose to pay extra from his own money if he’d like to have:
- a particular brand, model or design of an item
- special features not related to his disability support needs.
Case example
Faizal is 9 years old and has cerebral palsy which has recently been causing a lot of difficulty with his mobility. While he can walk, Faizal experiences discomfort and is at risk of injury when he walks without help. He’s referred to a podiatrist who trials him with orthoses, which are inserts to help support Faizal’s weakened muscles while walking. The trial is a success.
In her report, the podiatrist lists several brands of orthopaedic footwear that will support Faizal’s feet better than standard footwear when he’s using the inserts. The podiatrist recommends Faizal uses one pair of orthopaedic slippers to be used when wearing the inserts indoors, and two pairs of specialised footwear for outdoors. The specialised footwear options listed range from $230 per pair to $699.
Faizal’s mother, Nadya, asks for funding from us for:
- the orthoses
- ongoing podiatrist check-up costs, as Medicare does not fund these
- $2800 per year to cover the cost of three pairs of specialised orthopaedic footwear at $699 a pair and the cost of replacement pair if needed.
To support her application, Faizal’s mother gives us the report from the podiatrist which includes:
- the details from the trial of the orthoses
- Faizal’s strength measurements with a recommendation on the level of supervision he needs when he’s walking while wearing the orthoses
- a recommendation on footwear options to support Faizal’s current and future needs.
When working out whether funding for Faizal’s supports are reasonable and necessary, the planner considers the reasonable and necessary criteria.
We use the criteria to consider among other things if the requested support:
- will be, or is likely to be, effective and beneficial for Faizal, having regard to current good practice. The supports will achieve what Faizal needs, based on evidence of his continued growth and future support needs, the trial of the orthoses and the recommended footwear options.
- represents value for money. This includes assessing whether comparable options would get the same functional result for Faizal at a cheaper cost
- will enable Faizal to take part more in activities like other children his age, reducing his need for other kinds of supports, and be of long-term benefit
- are NDIS supports that relate to Faizal’s disability.
In Faizal’s case, the planner decides:
- the need for podiatry visits and orthopaedic supports relates to Faizal’s disability
- the orthopaedic footwear are NDIS supports
- evidence and recommendations from the trial show the orthoses and footwear are likely to be effective and beneficial for Faizal, and reflect current good practice
- the likely cost of the footwear given by Faizal’s mother is more expensive than would usually be expected for this kind of specialised shoe
- the podiatrist recommended more cost-effective footwear that would give the same benefits to Faizal
- the funding for the orthoses and podiatrist check-ups were assessed as reasonable and necessary.
- funding for these supports was approved.
The cost of $2800 for four pairs of specialist footwear was not assessed as reasonable and necessary.
Funding to buy four pairs of shoes per year wasn’t good value for money based on Faizal’s continued growth. Instead, funding for $750 per year was approved to cover the cost of three pairs of specialist footwear at approximately $250 a pair.
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