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NDIS Funding Guidelines

NDIS funds programs that are reasonable and necessary to support each participant based on his or her unique situation. It is sometimes difficult for participants to understand why NDIS decides not to fund particular programs, or why decisions are different for people with the same or similar disabilities as you.NDIS, in an effort to increase transparency in funding, released funding guidelines earlier this year that provide examples of some of the most common and confusing support programs, explaining whether or not they qualify as funding programs. .
Typically, NDIS will only fund programs that meet all of the following criteria
1. relate to the participant’s disability needs
2. Helps the participant achieve personal goals
3. Contributes to the participant’s social/economic participation
4, Provides good value for money: costs are similar to or less expensive than alternatives that could provide the same outcome for the participant; in the long run, purchasing the support may reduce the cost of funding other supports.
5. Effective and beneficial to participants
6. helps to maintain informal support for participants
7. NDIS has a responsibility to fund
NDIS will not usually fund if the following situations occur
-Your program has been suspended or discontinued
-You have flexible remaining funds available
-NDIS cannot consider changes without looking at the rest of your plan
-If your circumstances change significantly and you need to be assessed
-You need more funds to help achieve the changed goals and are asking for a lot
-You are using funds faster than specified in your plan
NDIS will usually not provide funding if the following situations occur
1. it is not related to the participant’s disability
2, Another government system or community service is responsible for funding the support
3. there is no evidence that the support will significantly improve the current living situation and benefit in the long term
4. it involves daily living expenses that are not directly related to the participant’s disability support needs (e.g., utility costs such as rent, groceries, or water)
5. the support may cause them harm or pose a risk to others
6. as income for the participant
Recently, NDIS made an update to the funding guidance, and this update includes new guidance materials and case examples on four types of supports: cell phones, medications, mental health supports, and home care supports.
Case 1: Cell Phones
Rebecca does not have a phone or internet connection at home. She asks NDIS to fund a cell phone so she can go online to make appointments with her service provider and use her cell phone to stay in touch with her support coordinator.
Will NDIS fund it?
NDIS will not usually fund a cell phone as it is a cost of daily living and not an additional cost of living as a direct result of your disability. Cell phones are a general household item and most Australians need one to communicate with friends and family. Depending on the NDIS’s reasonable and necessary funding criteria, the NDIS may consider allowing participants to access the device through the community (e.g. from a local library).
Although NDIS does not typically fund cell phones because the need for a cell phone is not a need that arises directly from your disability alone. However, if the need for an electronic device is an additional cost directly due to your disability, NDIS can provide funding. For example, you need additional software or equipment such as a screen reader to help you operate a smart device such as a computer, iPad, or cell phone.
Case 2: Medications
Cynthia requests NDIS funding for a medication that may help her manage her disability. She provides a letter from her clinician in support of her request. The letter emphasizes that the medication has been tested by people with disabilities similar to Cynthia’s and some improvement has been observed.
Will NDIS fund it?
NDIS cannot fund medications, whether prescription or over-the-counter, because NDIS is not the most appropriate agency to fund such programs. The health system, as part of the mass service, is responsible for subsidized or provided medicines and drugs for all Australians through the Medicare and Pharmaceutical Benefits Scheme (PBS).
Case 3: Clinical mental health support
Emilia has a psychosocial disability as a result of her mental health problems. She feels her condition is getting worse. She has asked NDIS to fund clinical treatment for mental health professionals. This funding would supplement the Public Health Service-supported mental health program she receives from her place of residence.

Will NDIS fund it?
NDIS does not normally fund clinical treatment for the following conditions, including:
1. clinical mental health related support, including acute, ambulatory and continuing care in the community, and rehabilitation.
2, Early intervention support and clinical mental health related support, including child and adolescent developmental needs.
3, Inpatient care with the primary purpose of hospitalization or clinical rehabilitation. This includes places where primary mental health care support is provided by primarily employed clinical staff.
4. Treatment for drug and alcohol dependence
This is because health systems are the most appropriate source of funding for these supports.
Case 4: Non-clinical mental health supports
Roxanne has been living with mental illness for several years. Her mental health has had a big impact on her life and she has an NDIS program to help her with her psychosocial disability supports.Roxanne wants to increase her independence and has asked the NDIS to fund capacity building supports to help her learn how to do daily activities such as paying bills and cooking with the aim that her need for support will decrease over time.
Will NDIS fund this?
NDIS will generally fund capacity building and social, community and civic engagement as long as they are not clinical in nature, are related to your ongoing psychosocial disability, and increase your functional ability and independence.NDIS expects that by providing funding to build capacity, it will gradually increase the independence of participants and eventually reduce the need for funding.
Examples of the types of non-clinical mental health supports that NDIS may fund include:
Helping you improve motivation, focus, knowledge and skills, resilience, and decision-making abilities to become more independent in your daily activities
Helping you work with public mental health, health systems, and other services to ensure that the supports you get outside of the NDIS meet your needs and help you achieve your recovery goals
Supporting you to actively connect with family, friends, and others
Case 5: Home Care
Jemma, who has Parkinson’s, lives at home with her husband, where NDIS-funded carers help her with some of her daily activities twice a week.
Jemma has recently had knee surgery and the hospital has given her a wound care plan that will provide hospital-level care (HITH) in her home: a community nurse will visit Jemma every day for 2 weeks to care for her surgical wound. However, her surgical wound became infected due to her diabetes. The doctor reassessed that her wound would take at least 3 months to heal. But Jemma found out that the health system only funded home care for the first 2 weeks.
She asked NDIS to fund her treatment of the infected wound. Her request includes funding for: community nurse visits for 3 months, wound care consumables and daily injections; and 3 additional NDIS caregivers per week because her husband can’t continue to provide Jemma with extra care and he needs respite.
Will NDIS fund this?
NDIS refused to fund community nurses and consumables used to treat wounds. This is because there is no evidence that wound care support is linked to Jemima’s Parkinson’s disease. The health system is responsible for services including HITH, not NDIS.
The current caregiver funding provided by NDIS does not meet the support she needs in her current condition. It is unreasonable to expect her family to provide all the additional care she needs. Therefore, NDIS has approved the services of an additional caregiver three times a week for three months to provide her with additional help until she regains her mobility.

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