This post is a follow on from 5 Things Special Needs Parents Should Know About the NDIS. In this post, my guest NDIS planner further explains 3 reasons the NDIS may decline your claim for support and why certain supports are not usually funded through the NDIS. These are important points to keep in mind when you next review your child’s NDIS plan.

There are several reasons why a support that your child needs may not be funded under the NDIS, based on your child’s situation and what you are asking for. Here, I will talk about three reasons that a support may be declined.

The support is considered a “day-to-day living cost”

All children in Australia have costs associated with supporting them to grow up including food, clothes, accommodation and even entertainment. When a support is considered something that every Australian household or every Australian child requires it is unlikely that the NDIS will provide funding to cover this expense for your child.

The following are examples of supports considered a “day-to-day living cost”:

PEG/HEN formula – all children in Australia must be provided with food to survive, in the same way that the NDIS would not fund your groceries the cost of the formula which replaces other food items for your child is considered an everyday cost.

Toys – many children with disabilities may prefer or even benefit a specific type of toy such as sensory toys and trampolines in the case of children on the Autism Spectrum. It is generally considered to be the responsibility of Australian parents to buy toys for their children that align with their skills and interests for birthdays etc. If, due to financial constraints it is proving difficult to purchase toys relative to your child’s wants and needs there are many toys you can make yourself and even toy libraries you may be able to access. This, unfortunately, is a difficulty faced by many Australians with or without children with disabilities and is not considered a disability-specific need.

Lessons – music, swimming, yoga, tennis etc. Any child in Australia wishing to develop a skill must pay tuition costs to receive tutoring in that subject. However, if your child requires extra support due to their disability (e.g. must have one-on-one lessons due to behavioural concerns or must have someone in the water with them due to active epilepsy) the NDIS may consider paying the difference in cost between the general cost of a lesson for any child and the cost associated with your child’s specific support needs.

iPads – this is one support that has caused much debate in the community! Use of an iPad for education and entertainment is generally considered a day-to-day living cost. According to the Australian Bureau of Statistics in 2014-2015 62% of Australian households accessed the internet using tablet devices.  When it comes to iPads for communication it is generally considered only if there is clear evidence from a speech therapist that all other supports (such as dedicated devices, paper-based communication strategies and sign language) have been sufficiently trialled and rejected due to the impact of the child’s disability.

This is by no means an exhaustive list of all supports considered day-to-day living costs but gives you an idea of why a support may be declined.

The support is better/already funded through the “mainstream”

“Mainstream” supports refer to supports provided by other existing government agencies. Below are links to a few factsheets outlining the responsibilities of the NDIS and other agencies relating to your child’s support needs.

·         Education

·         Higher education and vocational training

·         Family supports

·         Health care

·         Mental health

·         Transport

Unfortunately, sometimes the existing structures in other mainstream agencies may not work to your child’s advantage. We all know of schools who do not make adjustments as necessary and doctors with outdated views of disability. However, under the Reasonable and Necessary legalisation of the NDIS they are not able to fund to provide funding to bridge the gaps were other systems are not working as they should be.

It is considered a duplication of supports

Sometimes a child or family may benefit from having a couple of supports of a similar nature. For example, a power wheelchair for long distances and a manual one for popping in the back of the car, or a physiotherapist and an exercise physiologist working on different parts of the same strength and mobility goal. This is where the “necessary” part of Reasonable and Necessary comes into things.

For the NDIS to be sustainable (to have enough money for everyone who needs it for as long as they need it), supports are funded at the most basic level possible to ensure that the participant’s needs are being met and that no one is at risk. While it may make life easier and more convenient for the family to have a second manual wheelchair because the power chair is big and bulky, from an NDIS perspective all mobility needs should be considered in the occupational therapist when prescribing the original piece of equipment.

Similarly, either the physiotherapist or the exercise physiologist should be able to develop a program that addresses all aspects of your physical support goals. I will say again at this point that every child and situation is different, however, to meet legislative criteria, strong evidence must be provided to indicate that the NDIS is not funding a different version of the exact same support.

The NDIS is new, it’s big and it’s complicated. It can be easy to get caught up or confused by red tape, legislation and all the different information that’s flying around. This article was designed to give some insight and some tips into how decisions and how you can support your child to get the right supports the first time around. I wish you all the best in navigating this system and hope the NDIS can support your child and your family to be happy, independent and have all your needs met.

Kind Regards,

A. Planner

 

You can find further information about the NDIS at www.ndis.gov.au.

If you have questions about your child or their plan you can email enquiries@ndis.gov.au.

If you have feedback regarding your or your child’s experience of the NDIS you can email feedback@ndis.gov.au.

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