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NDIS Vs Health - Who Pays What?

Updated: Jun 10, 2022

When it comes to understanding the responsibility split between NDIS and the health system, it is not a straightforward topic. This has caused much confusion for many people including participants and the professionals within the scheme. Hence, one may find it difficult to easily grasp answers to the questions as to who funds what.

What is NDIS?

This is my favorite question. National Disability Insurance Scheme (NDIS) is a federal government-funded scheme. NDIS is responsible for funding supports required due to the impact of a person’s impairment on their functional capacity.

Who is eligible to receive NDIS funding for support?

The NDIS only provides individual funding for Scheme participants. To become a participant, people need to meet the NDIS eligibility criteria:

  • Be aged under 65 at the time of NDIS access

  • Have an impairment or condition that is likely to be permanent (lifelong)

  • Be an Australian citizen or Permanent Resident or hold a Protected Special Category visa.

So when would one expect NDIS to fund support?

Supports funded within NDIS are not designed to substantially change a person's functional capacity, but they are meant to support people to live an ordinary life with the functional capacity they have.

In General, NDIS funding responsibility is based on the following principles:

  • Supports are needed due to the impact of their impairment on their functional capacity and their ability to undertake activities of daily living.

  • Supports that are required to maintain the care, that is delivered or supervised by a clinically trained or qualified health professional.

  • Funding supports to enable a person with a disability to participate in activities of daily living, more specifically for people whose impairment has reached a point where they cannot participate on their own and the improvement to their capacity to participate is improbable.

  • Funding supports are related to the management of a person’s health condition if a person is unable to do it independently because of their disability.

Examples of these support types are as follows: