Here at Leap in! HQ, we’re asked a lot of questions about what the NDIS does and doesn’t cover in a range of common scenarios.
Some supports are provided by organisations other than the NDIS. These are referred to as mainstream and community supports.
As part of our Leap in! Presents series we presented an NDIS vs mainstream supports webinar. In this story, we’re captured the key points from the webinar about the types of supports available from the NDIS and mainstream and community services.
An introduction to mainstream and community supports.
Mainstream supports are the supports you can get from other government funded services, like health, mental health and education. These are available to everyone, whether or not they have a disability. Examples include Medicare, JobSeeker payments and schools.
Community supports are those available through community organisations, like religious groups, sporting clubs, local councils and charities. Many community organisations offer a range of supports for children, teenagers, families and older people. This includes advice, information, activities and practical help.
The NDIS won’t fund a support if it’s more appropriately funded or provided by one of these other services. However, supports purchased with your NDIS plan can complement those received from mainstream and community organisations.
Healthcare providers.
Healthcare providers in each state and territory are responsible for medical, mental health, dental care and some other related services. As a result, these items are not generally covered by the NDIS.
The health care sector is responsible for:
- Acute and emergency services
- General practitioners (doctors), paediatricians, psychiatrists, medical specialists
- Dental and orthodontal care
- Care, surgery and stays in both public and private hospitals
- Mental health diagnosis and treatment
- Aids such as crutches where they are not directly related to a person’s disability needs (for example, during recovery from surgery).
Top tip: The NDIS does not cover “the gap” where there is an out of pocket difference between the cost of seeing a doctor and the amount that Medicare pays.
Medicines and pharmaceuticals.
The NDIS does not cover the cost of medicines or prescription medications. These are covered by the health system and may be subsidised by the Pharmaceutical Benefits Scheme (PBS).
NDIS funds cannot be used to pay for medicines that aren’t subsidised under the PBS.
The NDIS may fund prescribed nutritional supplements related to a disability such as home enteral nutrition (HEN).
Diagnosis and assessments.
Assessment, diagnosis and treatment for health related issues and illness are usually covered by the health system and not the NDIS, with several exceptions.
Healthcare is responsible for:
- Assessing and diagnosing illness and injuries
- Treating illnesses and injuries, including related therapy supports
- Treatment for chronic illness not related to a disability such as diabetes
- Assessing and diagnosing disabilities, including autism.
Top tip: Children under 6 with developmental concerns may be able to access NDIS early childhood supports without needing a diagnosis or an NDIS Plan.
Some assessments are covered by the NDIS. For example:
- When allied health therapists require assessments to help identify interventions related to a person’s disability support needs
- Functional assessments at the beginning of an NDIS Plan to establish a benchmark. This can aid reporting for plan reassessments and identify progress against goals or needs.
NDIS versus school provided supports.
Under the National Disability Standards for Education, an education provider must take reasonable steps to ensure that students with disability can participate and use the facilities and services provided, on the same basis as a student without disability and without experiencing discrimination.[1]
School-based funding is provided for students in state, independent and Catholic schools although the programs and the amounts of funding available vary. It’s best to refer to your child’s school for information on the structure and types of support available.
The NDIS is designed to provide supports and services that are not funded by other mainstream or government services (including school programs).
As the school system provides some services that can be accessed to support the education of children with disability, the NDIS only provides funding for certain supports.
Education.
The school system funds teaching and learning assistance, such as teachers’ assistants and tutors including school, home school and alternative education.
The education system is also responsible for:
- Making access changes to school buildings
- Curriculum adjustments to suit individual learning needs
- Therapy support to help teachers adjust curriculum
- General training for school staff to support and engage students with disability
- Providing learning aids, assistive technology and electronic equipment such as braille textbooks and modified computers.
- Inclusion support such as Auslan interpreters.
School supports the NDIS may fund.
The NDIS is responsible for providing support for everyday activities that a student requires because of their disability, which are not specifically related to learning.
Examples of the supports that may be provided include (but are not limited to):
- Personal care and assistance while the student is at school
- Specialist transport required because of the student’s disability
- Specialised support needed for transitioning to higher education, training, or employment due disability
- Assistive technology that students need no matter what activity they’re doing, such as hearing aids, wheelchairs, personal communications devices
- Help for students to find or keep a part-time job.
It is important to keep in mind that these supports must meet all the other NDIS funding criteria before they can be included in your plan.
What the NDIS does not fund
- School fees
- School uniforms
- Supports that assist with education or school work
- Everyday supplies that all students use such as pens, text books, exercise books, rulers, stationery etc.
- School excursions and activities etc.
- Sporting equipment, musical instruments.
For more detail, view our previous stories Can the NDIS help my child at school and Study supports and the NDIS.
Employment.
The employment system helps employers hire and include people with disability in the workplace. This includes:
- Training and induction when you start a new job
- Workplace modifications and workplace equipment that allows you to do your job
- Transport within work activities
- Workplace support to follow disability discrimination laws, such as reasonable adjustments.
The Australian Government employment assistance fund (EAF) gives financial help to eligible people with disability and mental health conditions as well as employers. The EAF can help fund work-related modifications, equipment, Auslan services and workplace assistance and support.
The NDIS covers many employment-related supports including personal care in the workplace, help making the transition to work and transport support if you can’t use public transport due to your disability.
For information about what the NDIS can fund in relation to school leaver and employment support, and workplace assistance, check out NDIS employment supports: All you need to know.
Community services.
Both mainstream and community services may need to make reasonable adjustments to ensure people with disability can access their services. This includes things like providing ramps for buildings.
Some community-based organisations also provide funding for assistive technology and equipment for people with disability.
These include:
- Variety: Delivers grants, scholarships and other activities for children who are sick, disadvantaged or have a disability.
- Morris Children’s Fund Inc.: Provides financial support to purchase equipment and programs and services to enhance development and wellbeing.
State-based services.
Each state also has its own programs that deliver support to residents with disability. Where a person is able to access these programs, they are unable to access the same supports from the NDIS.
- Parking permits
- Companion cards
- Guide, hearing and assistance dogs
- Travel subsidies and passes
- Sports and recreation programs
Support is available. You just need to know where to look.
Beyond the NDIS, there are loads of mainstream and community supports that may benefit people with disabilities and their families.
However, sometimes it’s hard to know where to find them. If you’re unsure, there are several options to explore.
- Your local area coordinator (LAC) can connect you with mainstream and community and supports
- Your early childhood partner is likely to be well connected with other supports in your area
- Your plan manager, support coordinator or support worker
- Local community centre
- State and local government websites
We are here to help.
If you need some help to understand the different supports available or any other NDIS query, the Leap in! Crew is here to help.
Call us on 1300 05 78 78, email crew@leapin.com.au or sign up to Leap in! plan management today.