The National Disability Insurance Scheme (NDIS) is required by law to provide “reasonable and necessary supports” to help eligible people with a disability live more independently. Determining what supports are reasonable and necessary involves subjective assessments by the National Disability Insurance Agency (NDIA), which administers the scheme, or its contractors. This makes for a tricky process.
The NDIS has two arms. There are individual support packages available to around 475,000 people with high levels of assessed needs. There is also the more recently introduced Information Linkages and Capacity Building (ILC) program, which aims to assist all 4.3 million Australians aged 16-65 with a disability. This promotes inclusion of all people with disability into their communities by helping individuals and by building the community’s capacity to welcome them.
The NDIS hopes the links created through the ILC program will reduce reliance on specialist disability supports and individual support packages over time. Most of the media stories detailing failures concern people missing out on individual support packages and the lack of alternative supports available.
So, are NDIS participants receiving the necessary and reasonable supports they need to live a quality life?
What makes supports reasonable and necessary
The NDIS uses tight definitions when it determines reasonable and necessary supports and allocates individual support packages. It doesn’t duplicate other formal supports such as health and education. Nor does it pay for day-to-day living costs or informal supports already available from family and friends.
It is contrary to the NDIS philosophy to have a formula that dictates reasonable and necessary supports for a particular type and severity of disability – nor is it practical. Two people with the same type and severity of disability may have different goals and so different support needs. One person may want to pursue education and employment, while another may want more community activities.
The NDIA administering the NDIS is governed by the NDIS Act, the Rules and the Operational Guidelines.
These regulations require planners employed or contracted by the agency to help each applicant identify their goals and draft a plan. The plan sets out the supports needed to achieve their goals. Participants are then allocated funds for these supports, which must represent value for money. Funds can only be used to achieve the goals in the NDIS plan.
The guidelines say the NDIA will fund daily living activities, social activities, aids and equipment and home modification. Though in practice, it’s the NDIA assessor who determines what is reasonable and necessary for an individual, and whether the person gets an individual support package or misses out.
– Carmel Laragy