NDIA Accountability Project

Unintended consequences of gap payments for Disability Support Pension recipients

General issues around the implementation and performance of the NDIS

Submission 12 - Supplementary Submission

  1. I would like to bring a funding matter to your attention.

  2. Putting plans together- non NDIS supports. When plans are being put together, on alternate non NDIS sources of support are considered to mitigate the cost of care. This is a reasonable approach. For example, if a service is available via Medicare then this is factored into the funding of the plan.

  3. Structuring plans using all sources of care. a. Ms S NDIS number: xxxxxxxxx.Ms S’s plan was structured to make use of services available under Medicare then extended via NDIS funding.

    b. Assumptions. i. One would reasonably assume that if the NDIS is happy to fund a service then it would enable that service to be delivered by funding the gap left after the Medicare payment. ii. Plan Management. One would reasonably assume that under Plan Management that Ms S could pay the gap left after the Medicare payment to fund her service.

                                1. These assumptions are incorrect.

    c. Unintended consequences- short changing services.Ms S is on the Disability Support Pension and the gap payment is 20% of her weekly income. As Ms S cannot afford to pay the gap payment, she cannot access the services factored into her plan under Medicare. This has the unintended consequence of effectively short changing Ms S of the funded services because she is unable to pay the gap. d. Ms S is able to access the services when she uses her NDIS funding to pay the whole invoice.

  4. Comment. Ms S is one of many participants who have been caught in what superficially appears to be a reasonable decision making and funding process. The reality for people with a disability who are also on the Disability Support Pension is that if a service attracts a gap payment it becomes financially inaccessible.

  5. Recommendation. It is recommended that NDIS Plans: a. are fully funded for reasonable and necessary services; or b. the Plan factors in and authorises gap payments for services so that participants are not effectively prevented from accessing services that they have been deemed eligible for.