Understanding "Reasonable and Necessary" NDIS Supports

When it comes to using NDIS funding, the key phrase to remember is "reasonable and necessary." This is the standard used to decide if a support or service is eligible for funding.

What does "reasonable and necessary" really mean?

Let's break it down:

• Reasonable means the support is:
  • Relevant to your disability: It should help you overcome the challenges you face.
  • Effective and proven: There's evidence it works for people like you.
  • Value for money: It's a good investment, considering the cost and benefits.
• Necessary means the support is:
  • Essential for daily life: It helps you stay independent, safe, and healthy.
  • Not covered by others: It's something the NDIS funds, not another government service.
  • Linked to your goals: It helps you achieve your dreams, whether it's work, education, or community involvement.

Some examples of reasonable and necessary supports include:

• Support Workers: If you require assistance with personal care, daily living activities, or community participation due to your disability, support workers might be considered reasonable and necessary.

• Assistive Technology: Equipment like wheelchairs, hearing aids, or speech-generating devices can significantly improve independence and participation.
• Therapy: Occupational therapy, speech therapy, or physiotherapy can help you develop skills and manage challenges related to your disability.
• Transport: If public transport is inaccessible or unreliable, and you need to participate in work, education, or social activities, transport support might be deemed reasonable and necessary.
• Home Modifications: Changes to your home, such as ramps, widened doorways, or bathroom adaptations, can improve safety and accessibility.

Some examples of supports that might not be considered reasonable and necessary

• General household expenses: While these are essential for daily living, they are generally not covered by the NDIS unless directly related to your disability.

• Luxuries: Items or services that are considered luxuries or preferences, rather than essential for your support needs, might not be funded.
• Supports already provided by other government programs: If you receive support from other government programs, such as Centrelink or Medicare, the NDIS may not fund similar supports.

These are just examples, and the specific circumstances of each individual will determine what supports are considered reasonable and necessary. Your unique situation, goals, and needs matter. Talk openly with your NDIS Plan Manager, Support Coordinator or Local Area Coordinator to explain your needs and how the supports will help you.

The goal is to help you live your best life. By focusing on supports that are reasonable and necessary, the NDIS ensures your funding is used effectively to make a real difference.

What if there's a gap in funding?

Sometimes, even with NDIS funding, there may be a gap in coverage for resources. In these cases, the Enrich Support Program can be helpful. This program provides financial assistance to participants to purchase items that are not funded by the NDIS and that they cannot afford to buy themselves.

Additional Funding Options

If the NDIS doesn't consider a support to be reasonable and necessary, there may be alternative funding sources available. Here are some examples:

• EnableNSW: Offers programs like the Continence Aids Payment Scheme (CAPS), Home Respiratory Program (HRP), and Equipment Allocation Program (EAP) to provide assistance with specific types of equipment and supports.
• Youngcare: Provides grants for housing transition supports, home modifications, and equipment for young people with high physical care needs.
• Isolated Patients Travel and Accommodation Assistance Scheme: Offers financial assistance for travel and accommodation costs for specialized health treatment.

It's important to note that eligibility criteria for these programs may vary. If you encounter a funding gap, it's recommended to research and explore these options to find the most suitable support for your specific needs.

For more information:

• NDIS Guidelines: Reasonable and necessary supports