NDIS | Understanding the NDIS claims process

Understanding NDIS Supports, Funding, and the Claims Process

Do you have a valid National Disability Insurance Scheme (NDIS) plan because, due to Parkinson’s, everyday activities such as travelling, preparing meals, and accessing your home safely may require extra help. The NDIS is there to support you by funding services that are directly related to your disability and help you achieve greater independence. This article explains what supports can be funded, what cannot be covered, and how to navigate the process of claiming these supports, so you know what to expect and can plan confidently.

What are NDIS supports?

The NDIS funds supports that are deemed “reasonable and necessary” for eligible people living with Parkinson’s. This means that for a support or service to be eligible for funding, it must be directly related to your disability and help you participate more fully in everyday life. For instance, if your condition makes it difficult to get in and out of your caravan, an assistive handle recommended by a qualified professional might be funded as part of your home modifications or assistive technology budget. Similarly, if you need extra help to attend an event due to communication or mobility difficulties, funding might be available for a support worker to attend with you.

It is important to understand that while the NDIS funds extra support that you require because of your disability, it does not pay for everyday living expenses. This means that costs such as the price of event tickets, mainstream meal delivery fees, or standard moving expenses are generally not covered. When planning your expenditures, always check if the expense is directly linked to overcoming a disability-related barrier. If you are ever unsure, it is best to call your support coordinator, plan manager, the NDIS, or your Local Area Coordinator (LAC) for clarification.

For more detailed information on what supports the NDIS covers see our Ins and Outs list.

The process of claiming NDIS supports

When you are planning to claim a support through the NDIS, there is a clear process outlined to help determine what is fundable. Here are some key steps:

1. Consultation with Your NDIS Planner: During your planning meeting, discuss all the supports you think you need. Your planner will work with you to identify which supports are related directly to your disability and which ones can help improve your independence.
2. Evidence and Assessments: For many supports, particularly assistive technology or home modifications, you will need evidence showing that the support is essential for your independence. This could include a report from an occupational therapist or another qualified professional. For example, if you need a handle for your caravan, the report should clearly explain why this modification is necessary for you to access your living space safely.
3. Approval Process: Your plan manager or coordinator will submit the necessary documentation to the NDIS for review. The NDIS then assesses whether the requested support meets the “reasonable and necessary” criteria.
4. Funding Decision: If the support is approved, it will be funded within your plan budget. If it is not approved, you should receive clear reasons so you can understand the decision. If you disagree with the decision, you can discuss it further with your planner or seek a review.

Examples of What Can Be Funded

Understanding real-life examples can make it easier to know what types of supports might be available. While this is not an exhaustive list, here are a few examples relevant to young onset Parkinson’s:

1. Assistive technology for a primary residence

Assistive technology (AT) for a primary residence includes equipment or modifications recommended by your OT that help you overcome the barriers caused by your disability and increase safety in your home. This might include:

• Ramps and Entry Lifts: To ensure you can enter and exit your home safely.
• Handrails and Grab Bars: In hallways and bathrooms to improve stability and reduce the risk of falls.
• Accessible Door Handles: Special handles or automation that make it easier to open and close doors.
• Modified Bathrooms: Installation of accessible showers, raised toilet seats, or specialised basins.
• Adaptive Kitchen Equipment: Customised work surfaces or appliances designed to be more accessible.

Generally, if you live in a caravan and find it difficult to get in and out due to Parkinson’s, an assistive handle may be fundable. However, the NDIS will require evidence from a qualified professional, such as an occupational therapist, to show that the handle is essential for your safety and independence. It is also important that your caravan is your primary living space or a significant part of your daily life. If the caravan is only rarely used, the funding might not be approved.

2. Meal preparation services

If your disability makes cooking difficult or unsafe, the NDIS may fund a support worker to help with meal preparation tasks. These supports often fall under daily living or core supports. A support worker might help with:

• Meal Planning and Shopping: Helping you decide on healthy meals and making a shopping list. (But not the cost of the groceries).
• Cooking and Food Preparation: Assisting you in preparing meals safely in your own kitchen.
• Skill Development: Working with you to enhance your cooking skills so you might eventually prepare meals independently.

For this type of support to be funded, the NDIS will need evidence from your care team (for example, a dietitian or an occupational therapist) that shows you require assistance because of your disability. The funding is intended to help you build skills in meal preparation while ensuring your nutritional needs are met.

For example, after undergoing Deep Brain Stimulation (DBS) surgery, you may find it hard to prepare meals. Although services like Uber Eats or DoorDash are not funded by the NDIS because they cover everyday food costs, some meal services may be eligible if they separately itemise the cost of meal preparation. For example, providers such as Lite n Easy sometimes list the cost of preparation and delivery separately. If the preparation cost is directly linked to your inability to cook due to DBS recovery, this may be funded. Always check the invoice details and discuss your needs with your planner. It is very important that these services provide an itemised invoice. The food itself (the cost of ingredients) is considered an everyday living expense and is not funded by the NDIS. Only the part of the cost that relates to the preparation and the delivery—because it directly relates to your disability—can be eligible for NDIS funding.

3. Transport

The NDIS recognises that transport is a critical support for many people with disabilities. However, funding is only provided for the additional, disability-related aspects of transport needs.  For example, if you are unable to use public transport safely because of your disability, the NDIS can fund taxi services or other private transport options. This is especially important during times when you cannot drive yourself—for example, after a medical procedure or when your symptoms are more challenging. However, the funding is strictly for the participant’s own travel. Routine travel costs or standard commuting expenses that everyone incurs are not covered unless they are directly related to overcoming a disability-related barrier.

In circumstances where you require assistance to get into, out of, or while manoeuvring within a vehicle, a companion driver can be funded as part of your support services. These drivers are seen as part of the “reasonable and necessary” supports for participants who cannot travel independently. However, the NDIS will not cover the cost of additional travel for family members or the everyday costs of tree‐ing to travel that are not clearly linked with your disability. It is only your own transport needs directly affected by your disability that qualify for funding.

In some cases, if you wish to drive but require modifications to your vehicle (such as adjustments to the seating, controls, or hand controls), these modifications may be funded if they are proven to be essential for you to drive safely. However, if your condition means you should not drive at all due to safety concerns, the focus will shift to non-driving solutions like taxis or companion driving services.

4. Moving costs

Generally, the NDIS does not cover the everyday costs of moving house such as removalist fees, rental bonds, or transport. However, if your current home cannot be modified to meet your accessibility needs, and if moving to a more accessible home is directly related to your disability, the NDIS might fund specific supports. This could include help with packing, moving, or setting up your new home, provided you have evidence from a home modification assessor. More details can be found by checking NDIS guidelines on home modifications.

5. Everyday activities’ costs

While the basic cost of a gym membership, exercise class or dance lessons is considered an everyday expense and is not funded, if you need extra support to participate in dance lessons—such as a support worker to assist with mobility or communication, or a one-on-one exercise physiologist to help you plan and complete an exercise routine tailored to your Parkinson’s, the additional support costs might be funded. This falls under the “social and recreation support” category. Always ensure that the extra costs are linked to your disability-related needs.

In the context of events, this means that while the scheme does not cover regular admission fees or ticket prices (because these are considered everyday living expenses), it can fund additional supports or modifications if your disability makes it hard for you to attend on your own. When attending events like music or food festivals, the NDIS will only fund the extra support required due to your disability, not the cost of admission tickets. For instance, if you need a support worker to help you navigate a crowded event, the cost of that support may be funded. However, you will still have to pay for the actual event tickets for you AND your support worker, unless you have additional arrangements such as a Companion Card.

6. Respite for your care partner

Many carers occasionally wish to take time off for activities like a weekend away with friends, family or a health retreat before they burn out. Such retreats might be a way for a carer to recharge, practise self-care, or improve their overall wellbeing. However, we need to be clear about what the NDIS funding covers.

The NDIS is focused on funding supports for the person with Parkinson’s, not the carer’s personal leisure or self-care costs. The purpose of respite funding is to ensure that the NDIS participant continues to receive quality care while the carer is given a break. The NDIS will fund the care service (for example, the respite care or accommodation for the participant) during the time that the carer is on leave. The extra services are aimed at enabling the carer to have that break, rather than covering the cost of the carers’ retreat itself.

For instance, if a carer wishes to attend a health retreat, the NDIS may help by funding a respite care package so that someone else can look after the participant during that period. However, the actual cost of attending the health retreat – the retreat fee, travel, and any personal treatments – is considered an everyday expense and is not covered under your NDIS plan. In other words, the funding permits your carer to take a break by ensuring that the participant’s care is safe and maintained while you are away, but it does not pay for all the personal expenses of that break.

That said, some service providers may offer combined packages. For example, there are providers who run wellness camps or short-term retreat programmes that offer a dual service: they care for the participant while also providing opportunities for a carer’s well-being. Even in these cases, the NDIS funding only goes towards the care component that is directly related to the participant’s disability needs. Any leisure or non-essential upgrade for the carer would be paid for privately. For more on respite for a care partner, you can also check with the Carers Australia if you are registered in the Carer Gateway for respite funding, services and opportunities.

In practical terms, here’s what you should keep in mind:

1. Everyday Costs vs. Extra Support:
   • Everyday Costs: Basic fees for everyday living costs (e.g. bills, groceries), general moving expenses, meal delivery (e.g. Uber, Menulog, other fast food), memberships, class enrolments, or a standard dance lessons, event and festival tickets are seen as regular living expenses.
   • Extra Support Costs: Expenses for hiring a support worker, accessing specialised guidance from an exercise physiologist, or any individualised modifications to allow safe participation are potential candidates for funding, provided you can clearly demonstrate that these supports directly address challenges linked to your disability.
2. Documentation is key: To have these extra supports funded, it is important to get written reports or emails from your care team, such as occupational therapists, physiotherapists, or your GP. They can provide reports that explain why the extra support is necessary for you to safely and effectively participate in the activity.
3. Discuss with your NDIS planner: Always bring your requirements and supporting evidence to your NDIS planning meeting. By doing so, your planner can help determine which extra support costs can be included in your plan under the “social and recreation support” funding. Make sure to detail how the support will help you overcome specific barriers related to your Parkinson’s.
4. Review your plan regularly: Your needs may change over time. Regularly review your NDIS plan with your support coordinator or Local Area Coordinator (LAC) to ensure that your supports continue to reflect your current needs related to mobility, communication, and overall participation in recreational activities.
5. When in doubt, ask first: If you are unsure about any expense, do not hesitate to contact your NDIS planner, support coordinator, or LAC. This is the best way to get clarity before making any purchases or commitments.

The NDIS is a valuable resource that can help fund supports to enhance independence and quality of life when you have young onset Parkinson’s. While the NDIS covers a wide range of supports, it is essential to remember that it only funds what is directly linked to your disability and what is deemed “reasonable and necessary.” Before spending money on any support or service, always confirm if it is eligible. Consult your support coordinator, plan manager, or contact the NDIS directly to ensure you are fully informed.

By understanding what the NDIS funds and following the correct process for claiming supports, you can avoid surprises and ensure that your plan truly meets your needs. Whether it is an assistive handle for your caravan, extra support through a support worker helping with transport and meals after DBS surgery, or funding for a support worker at events, knowing the rules and gathering the necessary evidence can make the process smoother and more successful.

Remember, the journey to greater independence is a team effort. Make full use of the resources available to you, and never hesitate to ask for help if you are unsure about your funding options. Your NDIS supports are there to help you live a more fulfilling and independent life. You can talk to the NDIS by phone 1800 800 110, email enquiries@ndis.gov.au or their webchat.

References

• National Disability Insurance Scheme. (n.d.). NDIS Supports: Creating your plan, plan budget and rules. Retrieved from https://www.ndis.gov.au/participants/creating-your-plan/plan-budget-and-rules
• National Disability Insurance Scheme. (n.d.). Assistive Technology Explained. Retrieved from https://www.ndis.gov.au/participants/assistive-technology-explained
• National Disability Insurance Scheme. (n.d.). Transport Funding. Retrieved from https://www.ndis.gov.au/participants/creating-your-plan/plan-budget-and-rules/transport-funding
• Department of Social Services. (n.d.). Companion Cards. Retrieved from https://www.dss.gov.au/disability-and-carers/services-for-people-with-disability/companion-cards
• NDIS Operational Guidelines. (n.d.). Retrieved from https://www.ndis.gov.au/about-us/operational-guidelines