Getting started with the NDIS
Ask anyone in Australia about the National Disability Insurance Scheme (NDIS) and you’ll almost universally find these things in common:
- They know it has something to do with funding for people living with disability
- They know it’s a big pot of money
- They have no idea how it works.
Trust me, even many of us who live and work within the NDIS ecosystem find much of it bemusing. Truth be told the NDIS is doing a lot of good, but it is still very new (compared with Medicare which has existed for over 35 years) and the challenges it is taking on, are very complex.
The general idea of the NDIS is that people living with disability (aged between 7 and 65) have a safety net of funding to provide the supports they need to live as independently as they can and start to achieve their goals. It is this idea of supporting people to achieve their goals that empowers participants in the scheme to regain lost independence and dignity.
Whilst this basis for a government funded system is wonderful and unique, there are several complexities about the NDIS that just are not made clear from the outset.
First lets cover the basics, the NDIS is for:
- Australian citizens and permanent visa holders, plus a few special visa categories
- People between the age of 7 and 65 (younger and older Australians are eligible for other funding schemes)
- People who usually need support from someone, or use specialist equipment due to a significant and permanent disability
- People who, with additional supports, may be able to become more independent in the future.
NDIS Access Request Form
To get started, you will complete an Access Request Form with sufficient information regarding your disability and your ongoing needs. This is submitted to the NDIA planner and a review panel who assess your eligibility against certain criteria and decide on your eligibility.
This process can be a lot more complex than it sounds, and whilst you could manage the process yourself or with your doctor, we highly recommend you engage a good Occupational Therapist to help you to provide sufficient justifications for the various supports you need. You don’t have to do this, and the NDIA do not specifically require it, but in our experience, it significantly increases your chance of success if someone with experience with various disabilities and with the NDIS system is working with you.
A good occupational therapist will provide you with evidence-based written reports outlining your capability to perform tasks and speak to what you need in place to support them to complete these tasks and ultimately achieve your goals.
Your first plan
Once you have received an access decision, it is time to build your plan (that sets out your goals and the funding allocated) to meet your specific needs and requirements. You attend a planning meeting with a NDIS staffer who will ask you specific questions to ascertain your needs and what you do in daily life.
- Think about your supports and why you need them
- Ascertain your current and future goals- the aim is that you receive the supports based on your goals. Most people leave this vague and open
- Think about how well you complete the activities you enjoy on a scale of 1-10
You will meet with your Local Area Coordinator (LAC) to work out this plan. The LAC works in the local community and is your point person to connect you to the NDIS once your plan is established. This is your person when you get a new plan and will help you find your feet with regards to funding and connecting you to the Myplace portal. The LAC advocates on your behalf to the Planner.
The Planner works with the NDIA, much like the LAC to establish the NDIS in your life. The planner decides the categories and funding needs and is the one you escalate matters to when you are trying to work things out.
Your first NDIS plan will be for a set time frame, it could be 6 months, 12 months or something different depending on your needs. When your plan is coming to an end you will undergo a review to assess what your next plan should be. You can also trigger a review at any time if your circumstances change or you run out of funding.
Your plan will identify the funding allocated to you in different areas. Here are the main funding types (here’s a full list):
- Core funding – Support with your daily life and is the most flexible support
- Capacity funding – This funding is used to expand your skill and independence and you use it to access services such as support coordination, allied health, employment support
- Capital funding – Funding for assistive technology (AT) or home modification are placed in this section. When occupational therapist writes reports to gain funding for specific needs, the funds that are approved are placed in this section.
This is a lot to manage!
Well yes, it can be. Your funding can be managed in several ways and your NDIS planner will seek guidance from you as to how you want to manage it. You can choose from:
- Self-managed- upside you can but the things you need and claim the money back via the NDIA portal. Downside you will have to manage all of it yourself, increasing your responsibility. Make sure you get relevant documentation to back up your purchases in case you get audited by the NDIA.
- Plan Managed- NDIS places additional funding in your plan to allow you to get an agency to manage your funds. The agency act on your behalf and make life easier for you as you will not have to pay the invoices in your time. You will need to keep an eye on funds and instruct the agency as to what you want.
- Agency Managed- The National Disability Insurance Agency can manage your funds. Upside you do not have to worry about managing anything and you will only be able to receive support from those who have been registered by the NDIA. On the flipside, it limits your access to supports to those who only are registered with the NDIA.
In addition, if your needs require more ongoing support to coordinate the implementation of your plan, you may be eligible for funding (that will be in your plan) for support coordination. I have personally seen the huge benefit on requesting support coordination as they advocate for their clients and aim to move things forward for you. They also have all the connections to various Providers and have experience to help you get what you need.
Getting what you need
Once you have your plan and your funding, and you have access to support coordination or you are able to arrange it yourself, you can get started. If you need support for daily living, or physiotherapy or other types of therapy, this funding will be included as part of the Capacity funding, and you can start looking for a Provider.
However, if, for example, you need a wheelchair, your first NDIS plan is likely to include funding to assess exactly which wheelchair you need, rather than giving you money for the wheelchair itself up-front. If you need modifications to your home, there will be funding to have that properly assessed and quoted.
Often these Assistive Technology or Home and Vehicle Modification needs will require proper functional assessments and reports to be done by an Occupational Therapist who will also help to coordinate trials and quotes from the suppliers. Once the right product or solution has been fully worked out, this is then submitted to the NDIA for approval of the full funding required to deliver it. Once this is approved, the items can be purchased, and the works can begin.
Entering the world of NDIS can be very daunting. This process can take time and there will be moments of frustration, so it is important to focus on your goals and what is important to you. This is not a sprint, it is a marathon and having had clients engaging with services for a few years now, I can honestly say I have seen some incredible outcomes and lives turned around.