One of the questions Blue Badge is often asked is “will the NDIS fund my wheelchair?”
Blue Badge Insurance understands that accessing and participating in the NDIS can be confusing at any point in the journey. That’s why we engaged NDIS guru and support coordinator Caroline Daley to write a series of articles.
In them, she answers all kinds of NDIS questions like this one we’ve seen on our Facebook page and elsewhere. Caroline has helped develop NDIS policies and was the first person to self-manage an NDIS plan – for her daughter Siobhan.
The first step in getting the NDIS to cover the cost of your wheelchair is to be approved for access to the NDIS. Here are the steps.
You will know that you have access to the NDIS if you:
- are an NDIS participant with an individual NDIS plan, or
- have a letter saying you have been found ‘eligible for access’ to the NDIS
Once you are a participant of the NDIS, they will fund what they deem to be reasonable and necessary supports for you to meet your goals.
What are reasonable and necessary NDIS supports?
These includes things like therapist sessions, support to go out and about and help around the house. It also covers help with meals or getting ready, and even equipment to make life easier.
It’s important to remember that all funded items, allocated in response to your NDIS planning meeting, must relate to one of your goals. This is why it is better to have big broad goals, which your requested equipment will help equip you to achieve.
For example, “I want to be able to safely live in my own home” is a bigger goal than “I need help to prepare dinner”. Your LAC/planner can use the reasonable and necessary criteria to fund more supports that may be related to living at home but not related to preparing a meal.
The NDIS categorises funding into three types:
- Core (everyday support, mostly staffing)
- Capacity Building (equipment assessments or skill-building, usually by experts such as occupational therapists (OTs), physical therapists, psychologists, assistive technology providers, and so on)
- Capital (high-risk and low-risk assistive technology such as mobility equipment, vehicle modifications, prosthetic devices and orthotics, as well as home modifications)
When is a wheelchair a reasonable and necessary support?
If you have a clinical requirement to have a wheelchair (ie. you’ll need a report from your OT, or potentially your physical therapist, saying it is so) then getting NDIS funding for one is usually really simple.
A clinical requirement is related to your functional impairment and how a particular piece of assistive technology minimises/eliminates that impairment.
It does not even necessarily have to directly meet goals because the chair is seen as a core enabler of your ability to be mobile. If you have a clinical requirement to use a wheelchair, even if a goal is not specific about mobility/community, the LAC/planner will typically still fund it.
Whereas, for example, a mobility scooter does need to relate more to goals as the clinical need is often not as clear.
Where do wheelchairs feature in my NDIS plan?
The Capital category within your NDIS plan is where funding for wheelchairs is included. That is, if they are deemed a reasonable and necessary support.
Wheelchairs are a much more complicated, individual purchase than we tend to believe. Why? Here are some reasons:
- People often sit in wheelchairs for many hours every day. So, this equipment must be properly prescribed by a qualified expert. This is to ensure it meets the user’s needs in every way
- The environment you live life in (home, stores, hobbies) as well as your wheelchair accessible vehicle will also be looked at. This is to make sure you can use a particular wheelchair where you need to
As you uncover the answer to ‘will the NDIS fund my wheelchair?’, are you looking for more information about buying a suitable wheelchair? It’s a good idea to read through Blue Badge’s ‘User’s Guide to Wheelchairs’.
What is an occupational therapist’s role with NDIS wheelchair approval?
OTs are responsible for assessing your needs and trialing different pieces of equipment with you. They will do so in locations where you will use the equipment. This is done to ensure the wheelchair they recommend will suit you both now and into the future. The funding for this assessment and report comes under the Capacity Building category.
Funding for your wheelchair is situated under the Capital category. It can only be used to purchase the equipment approved from this assessment process.
When your OT gives paperwork to the NDIS, they will include at least one quote for the wheelchair. The NDIS will use this to put the funds in your plan.
Unfortunately, in the past there have been significant delays with some NDIS decisions. This often included equipment funding. Why? Because it was difficult and time-consuming to add funding for Capital equipment into your plan after your plan started. This created a long queue of plans waiting on this.
Thankfully, improvements to have been made to NIDS systems. Now, wheelchairs that cost less than $5000 can be approved by the planner/LAC. That is, they can now pre-approve funds for both the:
- assessment in the Capacity Building category, and
- wheelchair up to the value of $5000.
Wheelchairs over $5,000
Does your wheelchair cost more than $5000? When you have your planning meeting the NDIS Planner/LAC can tell the computer system it should expect you to provide a quote to buy a wheelchair during the plan.
This means that once you give them the assistive technology report from the OT, including quote, it is much quicker for them to approve the funds.
The new system ensures that the assessment and approval process can occur as quickly as possible. So, NDIS participants can access the support they need sooner.
Can I insure my wheelchair with NDIS funds?
Right, you now know how to answer the “will the NDIS fund my wheelchair” question. So are you wondering if the NDIS provides funding for insuring this type of mobility equipment? Good question.
Once you have your all-important wheelchair in-hand, seriously consider insuring it to help protect your lifestyle. Safeguarding your equipment with a reputable provider such as Blue Badge Insurance means you can get your wheels back quickly and easily if they’re damaged.
Unfortunately, there is currently no clear process for insuring your wheelchair using NDIS funding. This may seem odd given insurance is designed to protect your high-valued wheelchair. It is supposed to cover you/the NDIA for the cost of a new one if the worst happened.
Most LACs/planners will struggle to find a line item to put into a plan to cover insurance. Having said this, several Blue Badge Insurance customers have succeeded in getting their wheelchair insurance costs funded. So, we encourage you to ask.
What we do know is that NDIA-managed plans only allow NDIA-registered providers and the line items in the NDIS Support Catalogue. There are no line items for ’mainstream’ supports. However, if you self-manage your NDIS plan, you can use your funds more flexibly. In this case, it is very likely that you can pay for the insurance premium out of your NDIS budget.
Need more information? Find the “What can I buy checklist” on page 8 of the NDIS Guide to Self Management. You can work out if it is OK to use your NDIS plan to cover your wheelchair insurance premium.
Hopefully this article has laid to rest any questions you have around “will the NDIS fund my wheelchair”. If not, speak to your NDIS planner or LAC for more information.
Have any further questions about mobility equipment insurance? Contact Blue Badge Insurance on 1300 304 802 or visit the Blue Badge Facebook page.
About the writer
This article was written by Caroline Daley, a leading NDIS expert. She has held several roles assisting the NDIA, including writing the original NDIS documentation and fact sheets on self-management. She’s also a qualified NDIS Assistive Technology mentor, and speaks at dozens of events. Caroline began planHELP upon realising thousands of Australians struggle to effectively create and action their NDIS plans.