Elevates Support Care

What Conditions are Qualified to be Funded by NDIS?

The National Disability Insurance Scheme (NDIS) gives access to information and services to approximately 4.3 million Australians having a disability so that they can lead normal lives. Around $22 billion worth of funds to 500,000 Australians having a significant and permanent disability are reportedly distributed every year.

NDIS has immensely changed since its creation, so it may be challenging to understand the eligibility and requirements. To give you an idea of the scope of NDIS, we’ve written a quick guide on the conditions NDIS covers.

Understanding NDIS disability

Before learning what conditions NDIS covers, one must understand that NDIS only covers disabilities that are necessary and reasonable.

The NDIS operational guidelines and NDIS Act of 2013 serve as the basis for NDIS disability. The necessary and reasonable support must be connected to the person’s disability. As such, daily costs like grocery items are not covered.

NDIS also considers the other services given by networks like caretakers, family, community, and government agencies.

NDIS Disability Access Requirement

The National Disability Insurance Agency (NDIA) is the statutory agency that carries out the NDIS. They have created a list of conditions that NDIS will cover to help streamline the access process. There are four types of lists namely:

1. List A: Conditions likely to fulfil disability requirements

Intellectual disability

The participant must be assessed and diagnosed with profound, moderate, or severe intellectual disability. Diagnosis must be in accordance with the latest DSM criteria. For instance, the IQ must be equal to or less than 55 points. There must also be severe deficits in adaptive functioning.

Autism

A multi-disciplinary specialist team, including a paediatrician, clinical psychologist or psychiatrist, must diagnose the condition. They must have extensive experience in assessing Pervasive Developmental Disorders.

Cerebral Palsy

The participant must have severe cerebral palsy. This falls as Level 3, 4 or 5 in the Gross Motor Function Classification System or GMFCS.

Genetic conditions

These are conditions that usually lead to severe and permanent physical impairment. Some examples include Leigh Syndrome, Angelman syndrome, and Spinal Muscular Atrophies.

Brain injury or spinal cord injury

These are conditions that lead to quadriplegia, paraplegia, hemiplegia, or tetraplegia. There is a significant loss of movement and strength in the affected limbs.

Permanent blindness

Permanent blindness must occur on both eyes. This must be evaluated and diagnosed by an ophthalmologist as follows:

  • Corrected visual acuity on the Snellen chart is equal to or less than 6/60 in both eyes; OR
  • Constriction of 10 degrees or less in the better eye’s arc of central fixation; OR
  • Combination of visual defects leading to an equal degree of visual impairment caused by the first two points

Deafblindness

Diagnosed by an audiologist and ophthalmologist, leading to severe and permanent impairment of hearing and visual function

Permanent bilateral hearing loss

Greater than 90 decibels in the better ear

Amputation

Congenital absence of the two limbs

2. List B: Conditions that need more assessment

Some conditions need to be assessed further before they can be approved for funding, such as:

  • Conditions primarily leading to intellectual or learning impairment such as intellectual disability and Asperger syndrome
  • Conditions primarily leading to neurological impairment such as HIV dementia or vascular dementia
  • Conditions that cause physical impairment such as Epidermolysis bullosa
  • Conditions that cause speech and/or speech impairment such as Usher syndrome
  • Conditions that cause several types of impairment such as albinism and aspartylglucosaminuria

3. List C: Defined programs

Qualified participants and those who have already been receiving support from some Victorian schemes can access the NDIS. They no longer have to give proof of their disability.

Participants of Victorian schemes created before the NDIS can also apply for the following:

  • Disability Support Register (DSR)
  • Individual Support Package (ISP)
  • Therapy

The NDIS website has a whole list of schemes. Most of the participants of these schemes are already switching to an NDIS plan.

4. List D: Permanent impairment or early intervention

Children having permanent impairments like Global Development Delay or Down Syndrome can get disability support services. Assessments to prove the impairments are not needed. Their parents can get support via initiatives like Carer Payment.

NDIS support for people having a long-term mental condition

Mental health conditions may cause psychosocial disability. Not all that has mental health conditions will have a psychosocial disability. However, those who do so may suffer from social disadvantage and severe effects.

Those who have significant disabilities that are likely to be permanent can qualify for NDIS support.

Are there conditions not supported by NDIS?

The NDIS does not cover time-limited or non-ongoing conditions such as:

  • Acute injuries

For instance, decreased mobility because of an acute injury like lower limb fracture doesn’t fulfil the disability requirement. This is because the condition is expected to improve.

  • Chronic health conditions not linked to the person’s disability 

It is vital to delineate care and treatment for chronic health conditions and related comorbidities from disability.

For example, someone who underwent amputation because of peripheral artery disease in a diabetes setting would receive support if they met all the access requirements. However, the medical care or medicines for treating peripheral artery disease or diabetes are not covered.

All available information will be reviewed by NDIA.

The NDIA developed a comprehensive process to confirm if a potential participant fulfils the access criteria. This includes:

  • Reviewing all information given by the potential participant, like the details specified in the access request form.
  • Reviewing other sources of evidence and information such as relatives, carers, and medical professionals. The NDIA will only collect minimal evidence to decrease the assessment burden of the participant.
  • Interviewing the potential participant. They can also interview family members and carers if the potential participant gives their consent.

Make the most out of your NDIS plan with Elevate Support Care.

Elevate Support Care specialises in giving support to those who have an NDIS plan. Whether you need support in doing daily household chores or want to be part of a community, we can help. Call us on 1300 266 027 or email your enquiry to support@elevatesupportcare.com.au, and let us discuss how we can make your life easier and more meaningful.

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