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 typically fund this?
Yes, we would typically fund specialised footwear or orthotics for Huan, as this is likely to meet our funding criteria. We would need some evidence to show the support is needed because of his disability. This could be a report, letter or email from his therapist or podiatrist.
Why would we fund this?
Clothing and footwear are considered an everyday living cost that’s not due to a person’s disability support needs. This means they can’t be funded by us. However, we recognise Huan may need specialised footwear and custom orthotics as a direct result of his disability. In this case, they’re an additional living cost that is solely and directly as a result of his disability needs, and we may fund them.
To work out whether a support is reasonable and necessary for Huan, we’d look at the information he provided and compare it to the NDIS funding criteria to work out whether the specialised footwear and orthotics can be funded by us.
We’d need some evidence to prove the support is needed for his disability, such as written evidence from a therapist or podiatrist. This evidence would need to show how the specialised footwear or orthotics:
- are needed directly because of Huan’s disability
- will be effective and beneficial in helping with his disability-related issues, and if alternative interventions, for example gait retraining, haven’t been able to help with the issue.
- represent ‘value for money’, which may include evidence that a cheaper alternative wouldn’t be fit for purpose, for example off the shelf shoes with orthotics
- would be likely to reduce or avoid the long-term cost of other supports, for example additional care support hours.
What else do we think about?
We don’t fund specialised footwear for injuries, for example a broken toe, or to diagnose and treat a health condition.
This is because it is 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 needs
Case example
Faizal is 9 years old and has cerebral palsy which recently has 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 one pair of orthopaedic slippers to be used when Faizal wears the inserts indoors, and two pairs of specialised footwear for outdoors. The specialised footwear options that are listed range from $230 per pair to $699.
Faizal’s mother, who is his child representative, asks for funding from us for:
- the orthoses
- ongoing podiatrist check-up costs, as these are not funded by Medicare
- $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 compares them against the NDIS funding criteria. This includes factors such as whether:
- 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
- the orthoses and specialised footwear are value for money. This includes assessing whether comparable options, such as more cost effective footwear or a gait retraining program would get the same functional result for Faizal at a cheaper cost
- there’s enough evidence that the supports will help Faizal to be substantially more independent, take part more in activities like other children his age, reduce his need for other kinds of supports, and be of long-term benefit.
In Faizal’s case, the planner decides:
- the need for podiatry visits and orthopaedic supports is directly related to Faizal’s disability
- the orthopaedic supports are appropriately funded by us as they’re needed on a regular basis because of Faizal’s disability
- evidence and recommendations from the trial show the orthoses and footwear are likely to be beneficial and help with Faizal’s issues
- the likely cost of the footwear given by Faizal’s child representative 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
- funding to buy four pairs of shoes per year wasn’t good value for money based on Faizal’s continued growth.
The funding for the orthoses and podiatrist check-ups was 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. Instead funding for $750 per year was approved to cover the cost of three pairs of specialist footwear at approximately $250 a pair.
Faizal and his mother get advice from his therapist to buy the orthoses and specialised footwear with the funding approved in his plan.
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