The National Disability Insurance Scheme (NDIS) is designed to provide tailored support to Australians with disabilities, ensuring they can live ordinary lives. When requesting support from the NDIS, the principles of reasonable and necessary and value for money are prioritised before choice and control. There are several good reasons that this is the case and is vital to the long-term success and sustainability of the NDIS.
The NDIS is not designed so a Participant can take a holiday or paint their house. It is not intended for people to be able to take trips overseas or to the snow. If participants spend NDIS funds on what they would like or that other systems should fund, the whole NDIS is at risk for those who need it. One critical risk is that taxpayers could lose confidence in the scheme when things are purchased and should not be – this is especially prudent while Australians are in a “cost of living crisis” and everybody is tightening their belts. Many of these “wants” are beyond the reach financially of most people, such as overseas trips. It needed to be clearly stated, and it has been since the legislation changed. Over several years, I have been told by many participants and legal decision makers that they have misused NDIS funding for many expenses, including pets, Thermomix’s, overseas trips, and routine house maintenance, without them understanding how inappropriate this type of expenditure is. They have no concept that utilising NDIS funds inappropriately is a type of fraud against the Australian Government and is an abuse of the trust of the Australian public. Misusing NDIS funds not only jeopardises the scheme’s sustainability but also undermines the trust and support of the Australian taxpayers, which is crucial for the NDIS to continue supporting those in need.
Understanding the Principles of the NDIS
1. Reasonable and Necessary: Supports provided are directly related to the participant’s disability and are essential for their ability to live an ordinary life. Supports must likely be effective and necessary, considering the participant’s circumstances and the best financial means to achieve that outcome. For example, some new prosthetic limbs allow a greater range of features. However, they are not considered value for money because the same result (mobility) can be achieved with the cheaper option. This is the design feature of the NDIS. It is designed so people can access support and equipment related to their disability support needs.
2. Value for Money: This principle ensures that the support funded by the NDIS is cost-effective. The NDIS evaluates whether the cost of support is justified by its benefit and whether there are more economical alternatives that can achieve the same or similar outcomes. The NDIS will not fund a Rolls Royce when a Kia will do the job effectively, nor should it. Funding the most expensive option will place the long-term financial sustainability of the NDIS at risk. This is also known as the minimum viable product, a concept that refers to the most basic version of a product that still meets the needs of the users. In the context of the NDIS, it means that the supports provided should be the most effective and beneficial ones that can be funded within the available resources.
3. Choice and Control: This principle empowers participants to decide about their supports, including who provides them, how they are delivered, and when they are received. Under the previous disability system, supports were rationed, you had no choice over who your providers were, it was a take-it-or-leave-it situation, and people had no choice at all. The NDIS gives participants the autonomy to manage their own lives and support. This does not mean that “reasonable and necessary” and “value for money” are not considered first. Choice and control must be within boundaries. Over several years, I have heard choice and control used as a defence to funds being used in a way that wasn’t reasonable and necessary or a minimum viable product. People want 1:1 support because they don’t want to be supported in a small group when there is no disability-related reason why they can’t be. This is not what “choice and control” means in an NDIS context. To allow this to continue unabated places the whole NDIS at risk. I have been asked to support 100s of people who want this type of support and do not appear willing to accept any other model. This is often outside of the scope and intent of the scheme.
PlanHELP has supported hundreds of individuals navigating the NDIS; we have assisted our clients in generating 10s of millions of dollars in additional support, but only when we believe these supports are a minimum viable product for people to live an ordinary life. Choosing your own support is part of this and one of the great things about the NDIS. However, it is also one of the most significant risk points. The changes to the NDIS legislation allow the NDIS to choose providers when the participant’s choice and control results in choices that are outside of what their NDIS funds were intended to be used for. This is vital to maintain the NDIS’ integrity.
Why the Order Matters
1. Ensuring Sustainability: Prioritising “value for money” and funding “reasonable and necessary” support helps ensure that NDIS resources are used efficiently and as intended. This approach helps maintain the scheme’s financial sustainability and the trust and support of Australian taxpayers, which is vital in ensuring that the NDIS can continue to support participants into the future.
2. Maximising Impact: Supports that are “reasonable and necessary” and represent value-for-money are likely to positively impact participants’ lives, which the NDIS was designed for. This ensures that the funds are used to provide the most effective and beneficial support. When choice and control are used in a way that undermines reasonable and necessary and value for money, it puts the whole system at risk and shows to the NDIS that the risk of that individual exercising choice and control is too significant and could result in all funding being stated supports and agency managed to mitigate that risk. Public funds need to be spent as intended.
3. Equity and Fairness: By prioritising these principles, the NDIS helps ensure that support is allocated based on genuine needs rather than personal preference.
4. Empowering Participants: Participants are free to choose who provides their support; however, these choices are made within a framework that has determined that the supports are essential and affordable.
Conclusion
The NDIS prioritises funding reasonable and necessary support and value-for-money decisions before considering choice and control. This priority order is crucial to maintaining the NDIS’ effectiveness, financial sustainability, and the trust of Australian taxpayers. By balancing these principles, the NDIS can provide meaningful and sustainable support to Australians with disabilities now and into the future.