The National Disability Insurance Scheme heralds a flexible approach to supporting people with disability in the community. Enis Jusufspahic explains where the Scheme came from and how it operates.

The National Disability Insurance Scheme (NDIS or the Scheme) is federally administered by the National Disability Insurance Agency (NDIA of the Agency). It is funded by the states and the commonwealth.

The new approach recognises that every person is an individual, but also a member of the community, by allowing funding for individuals to access the community and to build communities that are more inclusive. As such, it is built on the underlying principle of enabling people with disability to live a good life, as each person understands it.

The Scheme developed in response to the issues in the historic Disability Support System. It is important to unpack the history so we can better understand how the Scheme functions.

Historic Disability Support System

The existing Disability Support System was funded by the states and the commonwealth and administered by state on a regional basis. Each state offered comparable core programs and a suite of individualised funding packaged targeting different groups of people with disability. Over time, this resulted in significant fragmentation and policy differences between states.

By and large, funding was allocated to service providers which were responsible for assessing client needs and managing and delivering services. Due to high demand and limited funding few service providers were able to offer true flexibility of service provision.

Road to the NDIS

In 2007, Australia ratified and adopted the Convention on the Rights of Persons with Disabilities; Article 19 of which established that persons with disability “must have access to a range of in-home, residential and other community support services to support their living and inclusion in the community, and to prevent their isolation or segregation from the community.”

In 2008, the commonwealth released a discussion paper asking the community about their experience of disability in order to inform strategic directions for the National Disability Strategy. Government received 750 written submissions and some 2,500 people attended the consultations. SHUT OUT: The Experience of People with Disabilities and their Families in Australia (Shut Out) reported on these consultations where people with disability spoke about:

• “Social exclusion and discrimination – 56 per cent of people surveyed identified exclusion and negative social attitudes as critical issues.
• Discrimination and human rights – 39 per cent of submissions identified discrimination and rights as a vital issue.
• Many called for an end to segregated services and options for people with disabilities, and their families, friends and carers, which people believed only reinforced and exacerbated prevailing attitudes. They sought a more integrated approach to support and greater availability of choice”.[i]

Productivity Commission – Insurance Scheme Approach

In 2011, the government tasked the Productivity Commission to answer the call of people with disability detailed in the Shut Out report. The Shut Out report recommended systemic reform and greater resourcing to move away from the welfare model of service provision to a person-centred approach that sees services not as charity but as social investment in realising the potential of people with disabilities.

The NDIS is hence expected to minimise the long-term costs of supporting people with disabilities and their carers while maximising the economic and social benefits by using actuarial modelling to estimate and manage the costs of care and support across the life-course of individuals.[ii]

NDIS System Design – three tiers

In 2011, the Productivity Commission published the Disability Care and Support Report recommending that the NDIS have three tiers.

Tier one – the insurance safety net

The lowest tier focuses on social participation, creating general community awareness about the issues faced by people with disability and promotes inclusion and opportunities.

Tier two – Information Linkages and capacity building (ILC)

The second tier, ILC, is designed to support a social model of disability support and reduce reliance on disability-funded support in the future. This includes things such as:

• information, linkages and referrals to connect people to the right support
• building the capacity of mainstream services to engage with people with disability
• improving community awareness, inclusion and accessibility
• building individual capacity
• local area coordination

Tier three – funded support packages

The highest tier provides individual funding packages to people with disability for the individual’s unique disability support needs as opposed to the current system, which allocated block funding to service providers.

NDIS Access requirements

In order to access a funded support package (Tier Three), a person must be:

• under 65 years of age at the time of lodging their application provided that the NDIS has rolled out in their region.
• meet the residency requirements

The person also needs to have a disability that:

• is attributable to an intellectual, cognitive, neurological, psychiatric, sensory or physical impairment;
• is permanent or likely to be permanent, whether or not of a chronic episodic nature; and
• results in a significant reduction in a person’s functional capacity in one or more areas of major life activity including: communication; social interaction; learning; mobility; self-care; and / or self-management;

Additionally, a person with disability who does not meet the significant disability requirement may provide evidence under the Early Intervention Requirement that provision of timely supports is likely to benefit the person by reducing future needs.

What does the NDIS fund?

The NDIS funds reasonable and necessary supports that help a participant to reach their goals, objectives and aspirations and to undertake activities to enable the person’s social and economic participation.

An individual’s reasonable and necessary supports take into account any informal supports already available to the individual (informal arrangements that are part of family life or connections with friends and community supports) as well as other formal supports, such as health and education.

Individual support services are funded across a range of areas including: education, employment, social participation, independence, living arrangements and health and wellbeing[iii].

NDIS and mainstream services

The Scheme is not intended to replace other mainstream supports. If another system is responsible for support, the Scheme cannot fund that support, even if the system responsible does not provide it. For example, the NDIS will not fund a support person to attend school with a child with intellectual disability because education is the Education Department’s responsibility but it will fund therapeutic activities at home.

NDIS Principles

People with disability having voice, choice and control over their supports are core principles of the NDIS.

Each person is to have an individual plan, which is to be confirmed by the Agency in accordance with the Scheme’s rules, most of which we have addressed in this article.

Flexibility of service provision in terms of when and who delivers your support services. This means not being tied to one service provider if you do not like their services.

Ability to amend your plan and appeal decisions by the Agency to do with your plan that you do not agree with.

Managing and paying for supports

In line with the self-determination principle, a person with disability may choose to take on the responsibility to manage their own package in whatever aspect they choose, have the NDIA manage it or nominate a funded plan manager.[iv]

Pre-Planning or getting ready for an individual plan

The NDIS gives people with disabilities opportunities to set and meet their goals. The difficulty is that many find this process of planning for the future and goal setting rather complicated and time consuming. NSW Government has funded a number of services that assist people with disability with planning (see articles in this issue on The Importance of pre-planning and My Choice Matters).

Implementing a funded support plan

Once a person with disability has their funded support plan they can start contacting service providers to provide the services that have been approved on their plan. When the service has been delivered the service providers puts in an invoice with the fund manager using the online portal www.myplace.ndis.gov.au

If the person with disability would like some assistance with implementing their plan, they can get some assistance from a Local Area Coordinator, or if they need more intensive support to put their plan in place, a Support Coordinator.

Scheme roll-out

The Scheme is rolling out in two phases. The first phase commenced in 1 July 2016 for the following areas: Central Coast; Hunter New England; Nepean Blue Mountains; Northern Sydney; South Western Sydney; Southern NSW; and Western Sydney.

The second phase of the rollout commences on 1 July 2017 for: Illawarra Shoalhaven; Mid North Coast; Murrumbidgee; Northern NSW; South Eastern Sydney; Sydney; Western NSW; and Far West.

People with disability who use NSW Government disability services are automatically deemed eligible for the NDIS. All apart from Community Care clients will need to put in an Access Request as in the initial trial there were a number of Community Care clients who were found not to be eligible for the NDIS.

People with the most significant support needs are transitioning to the Scheme first, including those people accessing the following state disability programs: Large Residential Centres; Group Homes; Community High; Community Access; Community Support; and Respite.

Once the Scheme is fully rolled out, there will be capacity to accept applications from people who do not use state based disability services. You can apply as soon as the Scheme rolls-out in your region but priority will be with those who are transitioning from the State based system. You can use an online tool to check whether you are eligible at www.ndis.gov.au/my-access-checker

Enis Jusufspahic is the Sector Support & Development Officer for Eastern Sydney located at Inner Sydney Voice.

Also see: Understanding NDIS terms

[i] SHUT OUT: The Experience of People with Disabilities and their Families in Australia (Shut Out)

[ii] High-level Principles for a National Disability Insurance Scheme, COAG

[iii] http://www.ndis.gov.au/participants/reasonable-and-necessary-supports

[iv] http://www.ndis.gov.au/participants/understandin g-your-plan-and-supports