What Does The NDIS Not Cover?

Do you want to know more?

Manage Your NDIS By Understanding What The NDIS Doesn’t Cover?

Written by: Anthea Taylor l NDIS Plan Management Team


As NDIS Plan Managers we are often asked by our National Disability Insurance Scheme clients “can I use my funds for…?”  This and “what can and can’t NDIS funds be used for?” are common queries from NDIS Participants, child representatives, plan nominees, support coordinators as well as providers.  Sometimes the answer is quick and simple, sometimes not so as what one NDIS Participant is eligible to use their funds for may differ from another NDIS Participant.  It all depends on the NDIS rules, criteria, guidelines, the NDIS Participant’s funded disability and the goals in their plan.

As a scheme governed by legislation but based on individualised plans, an NDIS Plan is structured around an NDIS Participant’s permanent and significant disability which substantially impacts their everyday life, and the short, medium and long term goals they wish to achieve.  As with the participant’s disability and the impact on their functional capacity being specific to them so too are the goals in their NDIS Plan.  The funds allocated to an NDIS Participant’s plan are for engaging and purchasing reasonable and necessary supports to help the NDIS Participant pursue and achieve their goals.

The reference to reasonable and necessary is peppered throughout resources provided by and about the NDIS.  The term is part of the NDIS vernacular and a key determinant of what an NDIS Participant can use their funds for.  Whilst it is the participant who is the best judge on what is reasonable and necessary for them, as a recap on previous Canny Plan Management articles, it is the National Disability Insurance Agency’s Chief Executive Officer or their delegate who determines what reasonable and necessary supports will be included in an NDIS Participants plan in the context to the NDIS Participant’s disability and their goals.

However, when it comes to the actual NDIS Plan provided to the NDIS Participant, the reasonable and necessary supports are generally categorised as Core Supports; Capacity Building Supports and Capital Supports.  Unless specifics are included in the plan, the NDIS Participant is left to decide what is, might be, could be, might not be, isn’t a reasonable and necessary support.  This can lead to confusion and concern over the utilisation of funds and anxiety about the potential for misuse of funds and having to pay the NDIS back.

Who’s In Charge of the NDIS Funds?

Part of our role as NDIS Plan Managers is to assist our clients to access and interpret the NDIS information about how they can use their funds and, provide guidance and advice on how to utilise their funds and comply with the NDIS rules to achieve their goals.  Providing our clients with reference to the NDIS resources or Administrative Appeals Tribunal information and decisions helps to support to develop and build their knowledge, capacity and choice and control with respect to their NDIS Plan.

An NDIS Plan Manager’s role has never been, nor should it be the “gatekeeper” of funds.  We do not determine what is reasonable or necessary or the supports an NDIS Participant can access.  It is however our role and responsibility to advise a client if a support contravenes the NDIS rules or expectations.  Before considering what the NDIS may fund, it’s important for NDIS Participants to be aware of the supports the NDIS will not fund:

  • The responsibility of another government department, body or community service ie. medical, health and education;
  • Not related to a person’s disability – including everyday household or recreational items if they are not modified to suit the participant’s disability;
  • Related to day to day living costs that are not related to an NDIS Participant’s support needs ie. food, utilities and rent;
  • Likely to cause harm to the NDIS Participant or pose a risk to others; or
  • Illegal.

What Can NDIS Funds Be Used For?

So, back to the question “can I use my NDIS Funds for…?”  Based on the premise of reasonable and necessary, an NDIS Participant can use their NDIS Funds to engage and purchase supports in relation to their funded disability if it:

  • Assists the NDIS Participant with pursuing the goals in their NDIS Plan;
  • Assists the NDIS Participant to undertake activities to facilitate social and economic participation;
  • Represents value for money;
  • Will or likely be effective and beneficial to the NDIS Participant with regard to current good practice;
  • Would not be reasonably expected to be provided by information supports including families, carers, networks and community; and
  • Would not be more appropriately funded through other channels such as State of Territory Services, Government departments, services or agencies.

NDIS Plan Funding Allocation

Subject to the NDIS Participant’s disability, the goals in their NDIS Plans and the funding allocation, they may be able to use their funding for:

  • Assistance with Daily Personal Activities
    • Assistance with self-care activities
    • Domestic activities
    • House cleaning
    • Gardening
    • Meal preparation and delivery (this must be a stated or specified in an NDIS Plan)
    • Short term accommodation/respite
    • Transport – to/from an activity, work or appointment
  • Assistance with Social, Economic and Community Participation
    • Assistance to access activities
  • Assistive Technology
  • Assistance with Accommodation and Tenancy Obligations (not rental assistance)
  • Disability related consumables
  • Finding and keeping a job
  • Home modifications
  • Improved Daily Living (allied health therapies)
  • Improved Health and Wellbeing (physical exercise and dietetics)
  • Improved Learning (transition from school to further education)
  • Improved Relationships (specialised assessment and skill development)
  • Social and Community Participation
  • Specialist Disability Accommodation
  • Vehicle modifications

National Disability Insurance Agency Criteria

Based on the criteria around what can and won’t be funded, the National Disability Insurance Agency has included a “What can you spend your funding on?” checklist in the NDIS Participant’s Booklet 3 – Using Your NDIS Plan to help NDIS Participants when choosing and deciding on using their funding.

  1. Will the support or service help to pursue your goals in your NDIS Plan?
  2. Is the cost of the support or service reasonable prices and is it the best value for money compared to other supports?
  3. Can you afford the support or service within your approved NDIS budget?
  4. Will the support or service help you to find or keep a job, help with your education, improve how you connect to your local community and improve the relationships you have with family and friends?
  5. Is the support or service something that should be funded by other government services instead?
  6. Will the support or service help you to participate in activities with friends and other members of your community, or help you find or keep a job?
  7. Is it safe?

Although they are closed questions only requiring a yes or no, the answer is dependent on the NDIS Participant’s interpretation of the support and their need and the alignment with their NDIS Plan.

The NDIS website also has a dedicated Would We Fund It section which provides examples of commonly requested supports and whether they are generally funded or not.

As part of the Canny Plan Management onboarding process for our new clients, we discuss their NDIS Plan and the options available to them to utilise and maximise their NDIS Funds.  And if at any time there is any doubt about engaging or purchasing a support, we encourage our clients to contact us so that we can provide information and advice to assist them with making an informed decision.

Trust Canny Plan Management when it comes to NDIS Plan Management

Who do you turn to when you have questions about your NDIS Plan or a loved one’s NDIS Plan?  Canny Plan Management has been specifically formed for the purpose of managing NDIS Plans and alleviating the stress and strain of managing your own or loves ones’ plans.  We care about you and helping you achieve your goals and aspirations.  We provide a personal, independent non-biased and responsive service and our team has extensive experience and expertise in the disability sector.

Get in touch with our team to have a chat to see if we can work together as part of your support network to help you reach and achieve your goals.

Head of NDIS Plan Management Anthea Taylor stands centre in the photograph wearing thick red framed glasses and wearing a white dress with a large black paisley print covering

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