Establishing NDIS Eligibility
Common Questions about NDlS & Disability services
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Establishing NDIS Eligibility
What supports am I eligible for under NDIS?
Support should be ‘reasonable and necessary’ and should:
- Help you achieve your goals and aspirations
- Build your capacity to actively engage in your community
- Facilitate more independence
- Enable more social and economic participation
- Provide value for money.
Things include resources you need to access learning, daily living, work, accommodation, equipment/assistive technology, transport, well-being and hobbies.
What does the term “reasonable and necessary” entail?
Anything in your request that doesn’t meet the reasonable and necessary criteria set by the National Disability Insurance Scheme Act (2013) will not be funded.
Supports must meet the following criteria:
- Assists you to pursue your goals, objectives and aspirations as mentioned in your plan
- Facilitates your social and economic participation
- Are value for money
- Are effective and beneficial for you, and in line with current good practice
- Are cognizant of what is reasonable to expect families, carers, informal networks, and the community to deliver.
- Is most appropriately funded through the NDIS
These points are legislated in the NDIS Act and are essential to planning.
What is the NDIS price guide?
The pricing for supports offered under NDIS are set in the price guide. It determines what a service provider can charge for supports.
For more information visit the price guide pages on our website.
Does NDIS pay for expenditures when I am on a holiday?
This is where you can refer to the reasonable and necessary checklist. A holiday is something that everyone must pay out of pocket to access, from flights to meals and accommodation.
However, the NDIS does pay for supports you need to access a holiday as that is an expense you specifically have to pay for in the context of your disability. A support worker or any assistive equipment you may need to go on a holiday can be paid for. This may also include any price difference between a standard hotel room and one that is accessible.
How much funding can I get?
Is NDIS one size fits all? Only the NDIS can tell you how much funding you are eligible to receive.
The NDIS assesses your individual situation and goals and what supports you need that are reasonable and necessary in order to achieve them. Your age, life stage, primary disability, functional impairment, living situation, and informal supports are all deciding factors that contribute to the NDIS’s decision.
That being said, take a look at the NDIS quarterly reports for your state to get an idea of the average funding packages available for different age groups.
Does NDIS impact the Disability Support Pension?
No, the NDIS is not means tested and has no impact on your DSP.
What does NDIS cost?
The NDIS doesn’t cost anything directly. Similar to Medicare, it is a universal insurance scheme paid through tax contributions. It is designed to complement health, education and other universal services.
What happens to my plan when I turn 65?
If you turn 65 as an NDIS participant, you will have the choice to either continue to receive disability supports in the NDIS or receive supports through the Commonwealth aged care system.
How can I access NDIS?
Learn more about accessing the scheme by going to this page on the NDIS website.
Why has my application been denied?
It is most likely due to not meeting the eligibility criteria as per NDIS’ review.
The NDIA may believe other service systems are more appropriate for delivering your supports.
What if I believe a mistake has been made about my eligibility?
If you believe a mistake has been made regarding your eligibility for the NDIS, you can request an internal review of the decision.
Step 2: Pre-planning and Planning
What is pre-planning?
Pre-planning is preparing all the things you need for a successful planning meeting. It can include:
- Gathering and keeping any necessary assessments, diagnosis and documents ready.
- Showing the status of your current supports and identifying additional ones that you need to live ‘an ordinary life’.
- Defining your short-term and long-term goals, and how you’d like to achieve them.
What is a participant statement?
Each NDIS plan needs to have a participant’s statement that covers their goals and aspirations. Your participant statement tells your personal story and gives an overview of your life circumstances. It will include important things like:
- what your life is now now and what you would like it to be
- where you live
- what you do
- the people in your life
- existing, informal and mainstream supports
- your goals and aims.
A participant statement helps the NDIS to understand the applicant. It is especially helpful if they are non-verbal or unable to attend the meeting. You may even seek support from family, friends and/or service providers about what to include.
What is a carer’s statement?
The NDIS Carer’s Statement provides the NDIS officer information about the nature of the care that a primary carer (usually ‘informal supports’ delivered by family or friends) provides. It can be part of the application and informs the planner about the impact of caring on the carer (impacts on work/study, aging, inability to lift and shower the person, additional insight into the day-to-day life of the person with a disability, etc.).
What is a goal?
Goals covers what you aim to achieve, learn or develop. An essential element of your plan is to identify short-term and long-term goals. A plan usually consists of two goals. A short-term goal is something you want to achieve in 12 months, a long-term goal is something that might take a few years.
Goals are an important component of your plan as all the supports funded by your NDIS plan is directly aimed at helping you achieve them. It is recommended that your goals are broad in order for maximum supports to be included.
Goals are one of the most important parts of your plan. This is because all the supports funded in your NDIS plan should directly link back to helping you achieve your goals. For this reason, it is recommended that your goals should be fairly broad so that as many supports as required can be included under the umbrella of that goal.
For example, you may want to move out and live independently in your 20s like other people in their 20s. This may take a number of years and require a range of supports like life skills training, daily support, positive behaviour support.
What are informal supports?
Informal supports are provided by parents, siblings and other family members. The NDIS takes the ongoing capacity of family members and carers to provide informal supports and identify alternative supports as needed (e.g. help with household tasks, transport, short-term accommodation, etc). The NDIS also has guidelines about what is reasonable to expect families to provide. It’s important to include all informal supports in your pre-planning activity as some of these may be able to be funded under NDIS.
For more information, read more about informal supports on the NDIS website.
What are in-kind supports?
Before the NDIS, the services delivered to people with disabilities were paid for by states and territories. In cases where these pre-paid supports and come under NDIS, NDIS participants will continue using these supports known as ‘in-kind’. Since they are pre-paid, you do not receive funding for them while they continue to be listed in your plan.
Read more about in-kind supports on the NDIS website.
Who is a Local Area Co-ordinator (LAC)?
LACs are either NDIA staff or NDIA Partners in the Community such as a not-for-profit organization. Their role is to assist you in gathering information about you to help you develop your plan. LACs also support you in implementing your plan and linking you to supports once the NDIA has finalized your plan.
Step 3: NDIS Planning Meeting
Who will conduct my planning meeting?
Planning meetings are either conducted by an NDIS planner or a Local Area Coordinator (LAC). In most cases, it will be a LAC.
Where will the planning meeting be held?
Where and when to hold a planning meeting is up to you. Most people choose to have the meeting at their home. You will likely be contacted via phone to arrange the details of your meeting.
If you feel the meeting is not going well, you have the right to discontinue the meeting and request it to be conducted at another time.
Can someone accompany me to the planning meeting?
You can have anyone you choose to be present at the planning meeting, whether a friend, family, or an advocate. An advocate can help you protect your rights. For a list of advocates, view the Australian Government’s Disability Advocacy Finder website.
What should I bring to the planning meeting?
This is where your pre-planning work comes in handy. We recommend you bring:
- Any pre-planning work you’ve prepared
- Any evidence of your disability (diagnoses, assessments, etc)
- Your bank account details (if you are considering self-managing all or a portion of your NDIS funding)
- Your myGov login and password details. For information on how to set up my Gov login read the Participant Portal User Guide on the NDIS website.
- A list of any questions you’d like to ask.
Step 4: Implementing your Plan
How will I receive my plan?
NDIS notifies you about your new plan being active by your preferred mode of communication. It also contains your myplace portal activation code, which expires within 10 days.
Post 24 hours of your plan is approved, it is available on the NDIS myplace portal so you should check to see whether it has been uploaded.
You will usually also receive a printed copy of your plan in the mail.
How do I put my plan into action?
- Your LAC or Support Coordinator will help you understand your plan and the supports you can pay for with your NDIS funding, how to implement your plan, and get you connected to new supports.
- Let your services provider know that you have received your plan. You can discuss your NDIS plan to ensure you are getting the right supports for your goals and funding.
- To receive services under the NDIS, you will need to outline what is called a ‘Service Agreement’. This document details how and when your supports will be delivered. Service Agreements are separate from your NDIS Plan. Your Service Agreement covers the details of how much our supports cost and how they will be delivered.
What is support coordination?
If you have requested support coordination and it has been funded in your Plan, you will see it listed. Support coordinators provide a higher level of support than LACs; they help you to:
- Understand your plan
- Connect you to support
- Help you negotiate rates and service delivery with providers,
- Ensure service agreements, as well as service bookings, are in place
- Assist you in preparing for your plan review
- Think of ways to help you get the most out of your plan and funded support
There are several levels of support coordination depending on the complexity of support required. It can help ease some of the day-to-day work of coordinating multiple services and providers.
Support coordination is capacity-building support and is, in many cases, only available for your First Plan.
Step 5: Reviewing and Appealing your NDIS Plan
What are plan reviews?
There are five types of plan review:
- A ‘light touch’ plan review
A ‘light touch plan review’ is a review with limited scope. Reviews are limited to smaller items like change of plan management type; adding/increasing assistive technology repairs; adding quotes for assistive technology (except home and vehicle modifications).
It can be completed over the phone and is usually quick to approve provided everything is in order.
- ‘Internal Review’
The decisions made by the NDIA are reviewable, including things like not being accepted as a participant as well as the provision of reasonable and necessary supports.
- Change in circumstances
You need to inform the NDIA about any major changes in your life (e.g. moving house, getting a job, being hospitalised for a long period or a carer family member getting sick or passing away). This can affect your plan and you may need more funds.
- Annual Plan Review
At the end of a year of your NDIS plan, a plan review takes automatically. This gives you the opportunity to assess if your supports are working for you and helping you towards achieving your goals.
- The Administrative Appeals Tribunal review
You can apply for a review by the Administrative Appeals Tribunal (AAT) if you are still not happy with your internal review.
The AAT exists outside the NDIA as an independent tribunal. An AAT review can only be requested after an internal review has been completed.
An application can be made 28 days after you receive your internal review decision.
What happens if my funds before my plan expires?
When your NDIS plan is developed, your funding is designed for the duration of your plan, usually 12 months.
If you are plan or agency managed, they ensure your funds last for you while sending you regular reports.
If you are self-managed, how you spend your funds is completely in your hands.
However, if a situation arises where you realize your plan funding is not going to last, it is recommended to get in contact with the NDIS.
If your plan funding is running out due to a change in your circumstances such that your needs have increased, you can submit a change in circumstance form asking the NDIA to reassess your situation.
When is my plan due for review?
Your review date is mentioned on the front page of your plan. Usually, these are every year, but they can also be every two years.
You will receive a call from the NDIA to get your review process started. If you don’t hear six weeks prior to your review date, we recommend calling your LAC to find out what’s happening.
What if my first plan ends before my second plan starts? Can I get funding for that time?
The NDIS will cover the costs during this period based on your previous plan. For more information, please contact the NDIS.
Can I still use my funds and access services whilst I’m going through a plan review?
Yes – you can do so provided you are spending your funds according to your existing plan.
How will my plan review be held?
You can either request it to be done face-to-face or over the phone. Similar to your first planning meeting, you can bring along, or include a family member, friend, or an advocate. The plan review is usually conducted by a Local Area Coordinator.
Do my NDIS funds roll over if they are unused?
No. While you have complete control over how to use your funds, you cannot roll over any unused funds. During every plan review, you receive a new plan outlining supports and funds for the coming year.
You can start by documenting the reasons for the unused funds (e.g. you were unsure about your plan, you needed a support coordinator to help you and it wasn’t funded, etc), or any other valid reasons that the planner/LAC can take into account during your review.
Your NDIS Planner can then take into consideration additional supports to help you optimize your plan if needed (e.g. if you needed a plan manager or support coordinator to help your plan in a better way)
Should I take any therapist or service provider reports or assessments to the plan review meeting?
Yes. The NDIS requires information on how your supports have helped you attain your goals, and any recommendations your service providers may have for supports you might need in the year ahead.
Specifically, reports about your Capacity Building support categories are extremely relevant.
It is recommended to request reports from your service providers and therapists at least six weeks or more prior to getting your report in time for your review meeting.
How do I estimate the funds I need for my next plan?
Use the NDIS Price Guide to help you get a rough estimate of the funds you’ll need based on the supports you are requesting.
What should I take with me to my NDIS Plan Review?
Here is a checklist of things to keep ready for your NDIS Plan Review:
- A copy of your NDIS Plan.
- A completed copy of the ‘Preparing for your plan review’ workbook.
- Information for your service providers about the supports they have delivered and the supports you’ll need to reach your goals for the coming year.
- If you have a decision-maker, they should accompany you to your meeting.
- You can also take a family member, support worker or friend to help you in the review meeting.
Can I request a plan that is above 12 months?
If you don’t think you’ll need a plan review after 12 due to your needs being unlikely to change, you can request a future plan of up to 24 months.
How do I make a complaint about the NDIS?
You can send any feedback or complaints regarding the NDIS to your planner. You can even contact your local NDIA office or send an email to firstname.lastname@example.org
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