NDIS and funding - children

NDIS

Introducing the National Disability
Insurance Scheme

The National Disability Insurance Scheme provides individualised support for people with permanent and significant disability, as well as their families and carers.

The primary purpose of the NDIS is to change the lives of people with disability, their families and carers for the better, enabling them to fully participate in the social and economic life of the nation and to live ordinary lives. (NDIS Corporate Plan 2013-16)

The NDIS website has a wealth of information and we highly recommend you become familiar with the content in depth. In particular, the information around eligibility, access and planning are important.

The National National Disability Insurance Agency

The National Disability Insurance Agency (NDIA) is the independent statutory agency, whose role it is to implement the National Disability Insurance Scheme Act 2013 (NDIS).

Key concepts of the NDIS

Accessing the NDIS

To become an NDIS participant you must:

  • Have a permanent impairment that significantly affects your ability to take part in everyday activities or have a developmental delay
  • Be aged less than 65
  • Be an Australian citizen or hold a permanent visa or a Protected Special Category visa
  • Live in an area where the NDIS has rolled out

The process to access funding

infographic describing NDIS application process

Pathways to access the NDIS

There are two pathways to access the NDIS depending on the age of the participant.

Children over 7 years

If you or your child is over the age of 7, access to the NDIS is via the NDIS Pathway. Follow the NDIS pathway to understand:

  • What is the NDIS?
  • Can I access the NDIS?
  • My first plan
  • Reviewing my plan

Children 0–6 years

If your child is aged 0-6 years, they will access the NDIS via the Early Childhood Approach. The early childhood approach aims to:

  • provide timely support to ensure that you are able to access the supports you need
  • give you information about best-practice early childhood intervention supports and how you can help your child
  • increase your confidence and capacity to manage and respond to your child’s support needs
  • increase your child’s ability to do activities they need or want to do throughout their day
  • increase your child’s inclusion and participation in mainstream and community settings like childcare or recreation
  • give you information about, and referrals to, other support services if needed, like parent support groups.

As an insurance scheme, the NDIS uses effective early intervention to reduce its medium to long term liability.

Early Childhood Approach Guidelines

Learn more about the early childhood approach in the guidelines - early childhood approach

NDIS Eligibility for Autism Spectrum Disorder

The latest version of the Diagnostic and Statistical Manual (DSM-5) categorises Autism Spectrum Disorder into 3 levels:

  • Level 1 – Requires Support
  • Level 2 – Requires Substantial Support
  • Level 3 – Requires Very Substantial Support

NDIS eligibility is based on reduced Functional Capacity in one or more of the following areas; Communication, Mobility, Social Interaction, Learning, Self-Care and Self-Management. Whilst a diagnosis of Autism at any level is likely to meet the access criteria, the NDIA have Lists A-E to assist them to determine eligibility.

Preparing for your NDIS planning meeting

Attending an NDIS planning meeting can be daunting. Preparation is the key. Completing a pre-planning workbook can help to prepare you for the planning conversation.

Association for Children with a disability have a NDIS planning workbook specifically for use by parents.

Goals and Aspirations

You will be asked to identify Goals and Aspirations as part of your NDIS planning conversation. Use the SMART acronym to ensure your goals are:

target icon denoting specificgraph icon denoting measurabletick icon denoting attainabilityeye icon denoting relevancetime bound icon

It is also useful to conceptualise your individual goals in a way that aligns them with the broader objectives of the NDIS. The scheme aims to support people with disability to increase their independence, increase social and economic participation and develop their capacity to participate in the community.

Tips for your planning meeting

  • Don’t go alone
  • Make sure you are well prepared
  • Go to NDIS information sessions if you can
  • Call the help line with any questions before
  • Speak to other families
  • Join one of the Facebook NDIS participant groups
  • Make a folder containing details about every single thing that you spend money on around disability support
  • Think about Goals and Aspirations for your plan

It’s important to know: If you don’t agree with the funding you or your child is allocated by the NDIS, you do not have to accept it. You can request a review of the decision.

However, reviews can be time consuming and emotionally draining. The better prepared you are during the planning process, the more likely you are to secure the reasonable and necessary supports that you need without the need for review.

What kinds of supports can be funded under the NDIS?

Before the NDIS planner or Local Area Coordinator makes a decision on what supports might be funded in a participant’s NDIS plan, they will take into account a participant’s network of informal supports (family and friends), mainstream supports (health, mental health, education) and community supports.

The NDIS will fund reasonable and necessary supports to help participants to reach their identified Goals and Aspirations.

‘Reasonable and Necessary’ are three very important words in the NDIS. It’s not as simple as whether a support might be ‘needed’, it has to meet Reasonable and Necessary criteria outlined in the NDIS Act 2013.

Reasonable and Necessary supports help participants to:

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Pursue Goals and Aspirations
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Increase independence
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Increase social and economic participation
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Develop capacity to take part in the community

In order to be Reasonable and Necessary supports must:

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Be related to your disability
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Not include day to day living costs
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Represent value for money
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Be likely to be effective and beneficial
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Take into account informal supports given
by family, carers, networks and the community

The types of supports that the NDIS can fund fall into three broad support purposes: Core, Capacity and Capital. These could include:

  • Daily personal activities
  • Transport to enable participation in community, social, economic and daily life activities
  • Workplace help to find and keep a job
  • Therapeutic support including behaviour support Help with household tasks
  • Aids and equipment including assessment, setup and training
  • Home modifications
  • Mobility equipment
  • Vehicle modifications

The NDIS will not fund a support if it:

  • Is not related to your disability
  • Duplicates support funded by a different mechanism through the NDIS
  • Related to day-to-day living costs
  • Likely to cause harm or pose a risk to others

Options for managing the funded supports in your plan

There are 4 ways to manage the funding in your plan:

self management iconplan management iconNDIS logo iconcombination icon

Self Management gives you maximum control over, and responsibility for, your NDIS funds. It allows you to use your preferred service providers, including both registered and non-registered providers of support. You can make decisions in line with your plan goals, including paying above the NDIS price guide limits or bargaining for a better deal from providers.

Plan Management gives you increased control over how your plan is used. The financial intermediary helps you to pay your NDIS support providers by processing claims and paying invoices on your behalf. Using a plan manager allows you to use registered and non-registered providers of supports, however you need to stick to the price limits determined by the NDIS price guide.

NDIA Agency Management gives access only to registered providers of NDIS supports. Registered providers claim for services provided directly from the NDIA provider portal. You can access the MyPlace participant portal to see what claims providers are making against your NDIS funds and monitor expenditure. Registered providers are only able to charge in accordance with the NDIS Price Guide.

A Combination of any of the methods of management might suit you. For example, NDIA agency management of Improved Daily Living will allow your Allied Health professionals (speech, OT, Psych) to claim directly for therapy services, while self-managing Core supports could give you the choice and control to directly engage a team of support workers to help around the home and in the community and stretch your budget further.

Helpful resources

What to do if you are unhappy with an NDIA decision

If you think a decision made by the National Disability Insurance Agency (NDIA) is wrong, you can submit an application for a review of a reviewable decision.

Many decisions made by the NDIA are reviewable, including things like being accepted as a participant, the provision of reasonable and necessary supports, and becoming a registered provider of supports.
A request for internal review of a decision must be made within three months of receiving notice of the decision from the NDIA. The staff member who works on the internal review will not have been involved in the earlier decision.

You can use the Disability Advocacy Finder to search for NDIS Appeals providers and disability advocacy agencies across Australia.

What if you are still unhappy after an internal review by NDIA

If you are still not happy after an internal review of the decision, you can apply for a review by the Administrative Appeals Tribunal (AAT). You cannot ask the AAT to review a decision by the NDIA until the decision has been internally reviewed by the NDIA.

For information about applying for a review by the AAT, see AAT: National Disability Insurance Scheme applicants or call 1800 228 333

“The NDIS can be very overwhelming, but once we got our son’s plan and package it was worth it”