Understanding Your Rights and Options Under the NDIS

The National Disability Insurance Scheme is Australia's most significant legislative overhaul of disability supports in history, but let's be honest, many individuals fail to capitalize on what the scheme offers. Why? It's not because information isn't available; it's more that NDIS can be confusing in the initial stages. 

NDIS covers millions of Australians with permanent and significant disabilities, yet people are often underutilizing their plans, failing to utilize their full funding benefits just because they are unaware of what's accessible to them.

Knowing your rights under NDIS means more than getting the most out of your plan budget (although that's important). It means that there is a relative level of control that you can exert over your services, who provides them, and how. 

The difference between working with a known understanding and passively accepting whatever anyone suggests is a world of change for your independence and quality of life.

​Please note: This collaborative article does not contain healthcare, therapeutic or financial advice. If you are concerned about your health or well-being, speak with a health professional or visit your nearest medical facility in an emergency. The links in this article may be affiliate links that I will be compensated for at no additional cost to  you.

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What NDIS Covers

What's interesting is that NDIS funding is separated into three categories and options relative to what can be covered.

Core supports cover your basic disability needs, the things relative to assisting you with personal care within the comfort of your home and maneuvering through your community, and in need of daily action. This is typically the most flexible category as it gives you the most control over spending the money.

Capacity building supports help to foster additional independence. These can include therapy sessions, finding employment, and supportive teaching techniques to learn new ways to accomplish tasks. Essentially, these are things that can improve you in the longer term, and therefore not necessarily a daily need for immediate, independent maintenance.

Finally, capital supports cover larger ticket items. These are one-time purchases (or few-time) purchases such as assistive technology, home modifications, and vehicle adaptations, all things that are not frequently purchased but, when necessary, can greatly improve independence during daily living.

What people fail to recognize is that you do not have to use all funding from one area just because it's allocated to you; if you're spending everything from one portion, that doesn't mean you're doing something wrong. Your needs are your needs; they are specific to you.

Who Provides Your Supports?

This is where rights come into play. You must utilize who you want to support you, end of story. No one can force you to use someone; no one can prevent you from switching, either.

When determining your support services, however, it is critical to work with a registered NDIS provider as this outlines someone who works under national guidelines and has proper supervision relative to what you're receiving for care as an additional layer of accountability.

But more than required status, this is where choice means something. You can interview providers; you can ask for their philosophies; you can check-in with other participants' reviews and in general, find someone whom you feel will be a good fit. Some people like larger companies that have more resources on hand; others want those who are smaller as they may receive more personal attention. Neither option is wrong; it's what's right for you.

You also have the option of managing your own funds through various capacities if you choose to take that level of autonomy instead. Being plan-managed or self-managed offers you more freedom relative to scope of employment and spending via the budget over agency-managed (where NDIS handles payments). 

Agency is more straightforward but less accessible, especially for those who are new to the system. Many people begin agency-managed until they feel comfortable enough to become plan-managed when they've gotten the hang of things.

Your Planning Meeting Rights

The planning meeting, with someone else's help, is where your NDIS plan is constructed or valued, and you're given much more autonomy than most people realize.

You can bring supporters with you, friends, family members, advocates, who help communicate your needs most effectively so you're not subjected to navigating that potentially overwhelming meeting on your own.

You can take your time. Planners are on a quota and time schedule; however, if they're going too fast, give you too little time on questions, or if you need a break or need to reschedule because you feel inundated and need more details from another source about why you're there, then that's perfectly appropriate.
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You can also appeal findings if something comes back unclear, even if it looks like everything requested was provided. Review processes exist for those planning meetings that don't approve what was most necessary or rational for what should've been approved and it should not be assumed at face value that something was rejected without further evidence if it was misunderstood.

Understand Reasonable and Necessary

This is a phrase thrown around NDIS a lot, but it's important that it makes sense to you whenever it comes through in conversation. If something isn't covered under reasonable and necessary circumstances, it's assessed through the following: relates to your disability/trialed goal achievement, represents value for money (less independent versus supported), something that NDIS should fund instead of health/education/family services, then it might not get approved for funding at this time.

It's not seen necessarily as a barrier but instead as a benefit to having funding applied to things that actually help improve your situation and independence. Yet the problem arises when a planner who's not privy to the minutia of someone's life doesn't automatically see why something makes sense, and thus requires a letter/confirmation from a part of your support team, therapists, doctors, specialists, to explain why certain options make sense for someone in this situation relative to others who are more supported and able elsewhere.

If something comes back denied for not being reasonable and necessary, it's not the end. You can appeal with further evidence relative to how necessary it is, whether it's necessary because someone else got it approved, and although it seems like a waste of time, many people successfully appeal through the review process of those denied decisions so long as those decisions get justified based on assessment steps taken.

Making Changes Between Plans

Your NDIS plan does not have to remain status quo from one review to another, if something changes in your life (a worsening condition, relocation period, need for different supported options) before your annual review, that's fine, and a new plan reassessment can occur. Unfortunately, life doesn't wait for annual planning meetings to happen within a timely window, and neither does NDIS,

Even within various approved categories (from conditions met/completed paperwork), you typically have access to change what you've been approved for spending as long as it's still within category orientation; thus if one area becomes covered with too many hours while another feels stretched too thin with time but has enough allocated funds remaining elsewhere that's reasonable per category definitions, that's acceptable even without an annual review unless there are quarterly review stipulations already set into place.

How To Lodge a Complaint

When issues arise, and they sometimes do, you have a process in place for complaints! Are they with a provider? Generally, these get settled at this level when providers realize there is concern.

The NDIS Commission has complaints about what's done or how it's done with providers; they take complaints seriously, investigate matters and hold those accountable who haven't met criteria.

But with your plan itself, for decisions made about who's included/excluded, funding levels and eligibility questions, the review process through NDIS separate once an internal review goes south (finds against what you're trying to argue) after the Administrative Appeals Tribunal gets involved once you've used all appeals at your disposal without justification required. Having an advocate or support coordinator can make this much easier on yourself so it's less stressful and let someone else ease their way through these debates on your behalf.

Information & Privacy Rights

Your information belongs to you. Providers must get consent to share information about supports and circumstantial changes in your life, they must fill out paperwork that states who accessed what from whom about, whom before you even have to acknowledge anything, if you're having sensitive matters explained through channels.

You're also empowered and encouraged to challenge anyone about what NDIS has on file about you, with substantiation, in terms of edits needed (negative or positive), who found out about such edits (need third parties), and all else in between.

This matters little but means everything because too many participants think they're working hard enough by taking what's dealt them without question, but that's wrong. Transparency should be welcomed instead of curiosity frowned upon which keeps participants in the dark about why something was offered or disqualified which ultimately hinders their abilities down the line should they try again without finding out why it worked/didn't.

Get The Most Out of Your Plan

Step one is knowing your rights; step two is putting them effectively into action. Always keep records relative to what's working or going wrong relative from start or content allocation with supporting documentation (notes also work) so when the time comes for review planning sessions, you've got a clear-cut case detailing what's effective, or essentially, lost in translation, or cut on budget.

Never be afraid to ask questions, from provider philosophical constructs to why assistive technologies aren't as effective as expected; if they've got time to help you, and you're willing to pay them, they shouldn't balk at any inquiries along the way.

​Your NDIS plan should work for you, not be subservient. The more you understand about your rights during this process, the more you're prepared potentially to set up supports worthy of bettering independence quality of life which ultimately should happen through getting there. Knowing what you're entitled makes all the difference.

Related: ​How To Work In Healthcare When You Have a Disability

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