Understanding the NDIS: how does the scheme work and am I eligible for funding?

On July 1 2016, the National Disability Insurance Scheme (NDIS) moved from a trial phase to a full national roll-out. In this series on Understanding the NDIS, we explore how the scheme works, why Australia needs it and the issues to be addressed before eligible Australians, such as many Indigenous people with disability, can receive the benefits they are entitled to.

The National Disability Insurance Scheme (NDIS) has been trialled in selected Australian sites over the past three years. It is now providing funding packages to more than 25,000 Australians under 65 who have a permanent impairment that substantially reduces their intellectual, cognitive, neurological, sensory, physical, psychological and social functioning.

The number receiving the packages is expected to grow to about 460,000 when the scheme becomes fully operational in July 2019. When NDIS participants turn 65, they have the option to stay in the scheme or receive support through aged care services. People who develop impairments from 65 years onwards receive aged care support.

There are 4.3 million Australians aged 16 to 65 with disability and many will not meet the criteria to be eligible for the NDIS. They may still receive assistance through the scheme’s newly introduced program providing information, linkages and referrals to connect people with disability, their families and carers with community and mainstream supports.

The NDIS will not replace the Disability Support Pension, which provides income support through Centrelink to people aged 16 to 65 who are unable to work because of their disability. The NDIS provides additional funding to meet the special needs of a person with disability, such as to buy a wheelchair or have assistance at home.

Why do we need the NDIS?

The NDIS was established in response to a 2011 Productivity Commission report that found disability services were “underfunded, unfair, fragmented and inefficient". The commission recommended a system of flexible individual funding packages that could be used to purchase disability supports.

Before the NDIS, state governments contracted disability service providers to deliver specified services. For instance, some delivered personal care in the home, while others provided day activity centres and other services for people with intellectual disability.

Service provision across different states varied. The person receiving support was usually assigned to one disability service provider and restricted to the supports that agency provided, even when they wanted something different. It was also difficult for people to change service providers.

Disability activists supported the 2011 recommendations for the NDIS scheme and its focus on choice and empowerment to help those with disability meet their goals.

The amount allocated by the NDIS varies across individuals. Some eligible people in trial sites haven’t received any funding, such as when their goals were to maintain informal contact with family and friends. By contrast, some received large allocations, including those leaving disability institutions who needed considerable support to live in a five-person group home, a shared flat, or alone with support. The average individual allocation to date is A$39,600.

How do I know if I’m eligible for the NDIS?

People with disability, or their family or advocate, can use the NDIS eligibility check list to see if they are eligible. If so, they can then apply to receive support through the NDIS. If their application is accepted, a planning conversation is held with an NDIS representative about the person’s life situation, current supports and hopes for the future.

NDIS funding is available for “reasonable and necessary supports” for people with disability to live a life as “ordinary” as possible. The NDIS website has two useful booklets explaining NDIS eligibility, what it aims to do and how it works. These are: My NDIS Pathway – Your guide to being an NDIS participant; and NDIS Ready — Communications Toolkit.

This includes funding for:

• helping people with personal care such as getting in and out of bed and showering, managing money, house cleaning and other domestic activities
• aids and equipment such as wheelchairs and hearing aids
• psychological, social and speech therapy and physiotherapy
• social participation activities such as in clubs
• transport so people can stay in touch with friends and their community.

Because the NDIS assigns funding to individuals, traditional service provider agencies will lose their government contracts and have to compete in a market environment to attract customers.

Supports can be purchased from any registered disability or mainstream services as long as they are in line with the person’s goals. A gym or social club membership can be included in a person’s plan.

A formal review meeting is held after 12 months, or earlier if requested, and changes made as required.

Individuals with allocated funding can select a registered service provider to manage and provide their support, or they can self-manage and negotiate the supports specified in their agreed plan, including employing their support workers.

Often family members can do this work on the person’s behalf. Only 7% of participants choose to self-manage their funds, while 35% combine self-management and agency management and 58% are fully agency-managed.

Positives and issues that need fixing

Early evaluations indicate that people like having the increased control and choice offered by the NDIS. One evaluation found 76% of participants were satisfied with the scheme. People reported improvements in living conditions (71%), health and well-being (60%) and more social, community and civic participation (42%).

Anecdotal reports from trial sites indicate many were initially confused by the changes and needed considerable information and support before they could use the NDIS effectively. The recent introduction of information, linkages and capacity-building (ILC) and local area co-ordinators (LACs) services is designed to address this problem.

But the NDIS has been likened to “a plane that took off before it had been fully built and is being completed while it is in the air".

People with social, cognitive and emotional impairments may find it challenging meeting requirements to apply for the scheme, seek information and negotiate their supports, even with the help provided. The most disadvantaged may miss out, particularly those from low socioeconomic and diverse cultural backgrounds.

Service providers face uncertain futures with governments ending their block funding. They have to compete to attract customers who choose their services. The government has been successful in stimulating competition and the service provider market is still evolving.

The NDIS is trying to address these issues. It is early days and the full impact of the scheme is to be determined.