What does the NDIS cover? What does the NDIS cover?

What does the NDIS cover?

16 August 2016 | Health Sector

The Administrative Appeals Tribunal in McGarrigle v National Disability Insurance Agency (NDIA) affirmed the decision of the NDIA to only partially fund transport costs for a young man under the National Disability Insurance Scheme (NDIS).

In July 2016, the progressive roll out of the NDIS finally commenced. It is expected that the NDIS will be operational in all States and Territories (other than Western Australia) by 2019. As more participants enter the NDIS, it will be important to understand who is eligible to participate, and what supports a participant is entitled to receive, under the scheme. The recent case of McGarrigle v NDIA [2016] AATA 498 has considered the extent to which transport costs will be funded by the NDIS.

The NDIS funds access to “reasonable and necessary supports” required by an eligible participant to assist them to undertake activities that enable their social and economic involvement in the community, and work towards their goals and aspirations.

In order to be considered “reasonable and necessary” the support must:

  1. Be related to the person’s disability.
  2. Not include day to day living costs that are not related to the participant’s disability support needs.
  3. Represent value for money.
  4. Be likely to be effective and beneficial to the participant.
  5. Take into account informal supports given to participants by family, carers, networks and the community.

Some examples of “reasonable and necessary supports” include:

  • Home modification design and construction
  • Therapeutic supports including behavior support
  • Transport to enable participation in the community, social, economic and daily life activities
  • Help with household tasks to allow the participant to maintain their home environment
  • Vehicle modifications
  • Mobility equipment
  • Help to a participant by skilled personnel in aids or equipment assessment, set up and training
  • Workplace help to allow a participant to successfully get or keep employment
  • Daily personal activities

McGarrigle v NDIA

Liam McGarrigle (by his mother) sought a review of the decision of the NDIA to partially fund the annual cost of his transportation, on the basis that the decision was incompatible with the objects of the NDIS as the support rendered little or no benefit if only partially funded. The transportation facilitated Liam’s involvement in a community group program and his employment.

The Tribunal agreed with the NDIA that funding for 75% of the transportation costs was a reasonable contribution. The Tribunal acknowledged that by only partially funding the costs it imposed an additional burden on Liam’s family – both in time and money – however, decided that 75% was a reasonable contribution for families generally.

This case highlights the tension between the cost of the scheme and the extent of its benefits. There are already issues surrounding the NDIS’ funding. It is likely that benefits to participants will be closely scrutinized and, on occasions, narrowly defined so that the NDIS remains within its budget.

For more information on the NDIS, please click here.

The article was written with the assistance of Isobel Yule and is part of our August 2016 edition of HealthFiles. You can read the full version of HealthFiles here.

Robert Samut

Robert Samut

Principal