What supports are covered by NDIS?

The National Disability Insurance Scheme (NDIS) helps cover supports and services that help people with disabilities to live their everyday lives. This includes supports that enable you to live independently at home, maintain a job, or enjoy hobbies and spending time with family and friends. As an NDIS participant, you can use your budgets to choose and pay for these supports based on your goals.

Here’s a simple guide to what supports you can claim under the NDIS if you’re eligible. 

What are claimable supports? 

Claimable supports are services and aids that the NDIS pays for to help you reach your goals and improve your overall quality of life. These supports are listed in your NDIS plan and can include things like personal care, therapy, and assistive technology. To be claimable, supports need to match the goals and needs set out in your NDIS plan. 

Categories of claimable supports

1. Core supports 

Core Supports help you with daily activities so you can live independently and be active in your community. This includes help with personal care, household tasks, and low-cost assistive technology. 

You can use Core Supports to be more active and social. For instance, you might get help from a support worker to attend a class or a group activity. Core supports are flexible and can be used for various needs listed in your NDIS plan. 

Here’s an example: If Kai uses Core Supports to get help with daily activities like cooking, and later feels confident enough to need less support, they can adjust their budget. Kai might choose to use the extra funds for a weekly pottery class instead of the cooking support. 

2. Capacity Building Supports 

Capacity Building Supports help you develop skills and abilities to reach your long-term goals. This includes services like therapy, skill development programs, and training to help you find and maintain a job.

For example, you might use these supports for occupational therapy to improve daily living skills, or for accessing exercise or diet advice to improve your health and wellbeing.

Unlike Core Supports, you can't move funds between different types of Capacity Building Supports. 

 3. Capital supports

Capital Supports cover high-cost equipment, technology or modifications that help you be more independent. This includes things like wheelchairs, communication devices, or home modifications. For example, if you need a modified vehicle or an accessible bathroom, you might be able to use Capital Supports for these costs.

This budget can only be used for these specific needs and can’t be used for anything else. 

What is a ‘reasonable and necessary’ claim? 

Many activities and services are covered by the NDIS under the term 'reasonable and necessary.'

Knowing what counts as 'reasonable and necessary' helps you figure out which supports you might need and what you can claim. 

How does the NDIS define ‘reasonable and necessary’? 

Reasonable – a service or item that is considered to be fair. 

Necessary – a service or item you need because of your disability. 

To be considered reasonable and necessary, a support or service must:

1. Must be related to your disability 

Anything claimed under the NDIS needs to be directly related to the participant’s disability For example, podiatry – which treats foot, ankle, and leg issues – isn't covered for general disabilities but may be for conditions like cerebral palsy or Down syndrome. The NDIS allows some flexibility if you can show that certain treatments help with specific disabilities. 

 2. Must not include general day-to-day living costs 

The NDIS doesn’t typically cover everyday expenses like groceries, clothing, or shelter. These costs are considered basic needs and are typically covered by other programs or private means. The NDIS covers many items and services, but they must be related to the individual's disability and plan. For example, while food itself isn't covered, the preparation and delivery of food might be claimable. 

3. Should represent value for money

Value for money means that the cost of support should be fair when you consider the benefits and other options available. More expensive supports might be worth it if they save money in the long run. For example, if high-quality noise-cancelling headphones help block out the noise, they might be a good investment, even if they cost more than cheaper headphones that aren’t as effective.

4. Must be effective and work for the participant

Some supports aren’t covered by the NDIS because there isn’t enough evidence to show they’re proven to work. Some items, like weighted blankets, considered ‘high-risk’ and cannot be funded without getting approval from the NDIA first. It’s your responsibility to get advice from a relevant professional before buying high-risk assistive technology.

5. Should consider other support from government and community

The NDIS works alongside, but does not replace, other government and community resources. Before claiming something under the NDIS, check if it's already covered by other programs. For example, bulk-billed GP visits are covered by Medicare, not the NDIS. The NDIS won't accept claims for services that are already paid for by other insurance or programs. 

Get help understanding claimable supports 

Understanding what supports are claimable helps you make the most of your NDIS funding. It ensures that you can access the services and aids you need to meet your goals without unnecessary out of pocket expenses. By following these guidelines, you can manage your NDIS plan effectively and get the support that’s right for you. 

nib Thrive plan management provides experienced guidance and support when it comes to making NDIS claims and maximising your plan funding. Head to nib Thrive to find out more.