'Reasonable and necessary' explained

‘Reasonable and necessary’ explained

Anyone transitioning to the NDIS will have heard the phrase “reasonable and necessary”, but what does this actually mean?

What are reasonable and necessary supports?

Reasonable is something that is fair.

Necessary is something you must have because of your disability.

The NDIS funds reasonable and necessary supports relating to a person’s disability to help them live an ‘ordinary’ life and achieve their goals. This may include support with education, employment, building independence, living arrangements or general health and well-being.

When you attend your planning meeting, the NDIA Planner will talk to you about your needs and goals to assess which supports are reasonable and necessary for you. Your planner will assess whether a support request is:

• related to your disability
• not a mainstream cost that is unrelated to your disability support needs
• value for money
• likely to be effective and beneficial to you.

They will also take into account the unpaid, informal supports provided to you by family, carers, and the community. They will also consider other formal supports such as health and education services that don’t need to be funded through the NDIS.

Everyone’s disability and support needs are unique. What may be considered unreasonable for one person may be considered quite reasonable for someone else with different support needs.

Don’t assume your planner will fully understand your or your family member’s needs. Be prepared to explain why the supports you are requesting are reasonable and necessary to your situation. Where possible, you should provide supporting evidence that proves a support is needed.

Examples of reasonable and necessary supports

Ultimately, reasonable and necessary supports are those that will help you to pursue your goals, live more independently, take part in work or social activities, and be more active in your community.

Here are some examples of supports that are often deemed reasonable and necessary:

• support workers to help with personal care activities
• therapeutic supports like occupational therapy, speech therapy or behaviour support
• support with employment to help you get, or keep, a job
• transport to help you participate in activities
• help with household jobs
• aids and equipment to help you do things independently
• home modifications
• mobility equipment to help you get around more easily.

It’s important to note this is not a complete list. While these supports are commonly funded, every plan is different and your funding will always be based on your personal situation.

Bridging the gap

The NDIS exists to close the gap between having a disability and not having a disability.

Ask yourself – would someone without a disability be expected to pay for this?

If the answer is ‘yes’, then chances are it is a mainstream cost. Things like housing, food, holidays and vehicles are considered mainstream costs, even though people with disability often need or use these things. Because they are not disability-specific, mainstream costs are unlikely to be covered by the NDIS.

Below you’ll see an example of the difference between a mainstream cost and something that the NDIS might cover.

An example of reasonable and necessary supports:

Tim has a disability and one of his NDIS goals is to attend more football games.

Tim will need to use his own money to buy the things that someone without disability would generally pay for. In this example, this would be things like:

• the ticket to the game
• a pie
• a drink
• a jersey to wear.

However, the NDIS could fund things that would help make attending the game more accessible for Tim. This could include:

• a support worker to accompany Tim to the game
• specialised transport that meets his mobility needs (if necessary).

But who is buying the ticket for the support worker?

Tim would likely have to pay for that ticket too (unless the football club accepts Tim’s companion card and allows the support worker to attend for free).

Looking for more NDIS tips? Visit our NDIS Information page or call 1800 112 112 to speak to one of our NDIS experts.