National Disability Insurance Scheme
The National Disability Insurance Scheme is a scheme of the Australian Government that funds reasonable and necessary supports associated with significant and permanent disability for people under 65 years old. The scheme was introduced in 2013 following the "Make It Real" community campaign and advocacy from disability groups, and is governed by the National Disability Insurance Scheme Act 2013. The scheme is administered by the National Disability Insurance Agency as part of the Department of Health, Disability and Ageing and overseen by the NDIS Quality and Safeguards Commission.
The NDIS model allocates funding to an individual, with the individual, their guardian or a private "plan manager" purchasing goods and services from suppliers. The scheme is entirely publicly funded and not means-tested, with recipients not purchasing or contributing to the scheme directly. The NDIS is independent of the Disability Support Pension and any state and territory disability programs, although NDIS navigation services may help individuals access these supports. The NDIS exclusively funds disability supports, not healthcare-associated costs. These remain publicly funded under Medicare and state and territory government health services.
In 2024, legislation was passed to reform the NDIS to better manage the cost of the program and the efficacy of supports provided. The package provides around to improve regulatory and evidence-based purchasing mechanisms, revise local linkage services, and reform NDIS pricing to improve transparency and predictability. The legislation was introduced in response to the Independent NDIS Review, concerns that some NDIS participants and suppliers were engaging in fraud, and an increase in low-value supports being funded by the scheme.
History
Context
In the 1800s, the states and territories operated asylums and other institutions for disabled people not long after their establishment, replicating the predominant model of treatment in the United Kingdom. These institutions were often large and residential.The Commonwealth Invalid and Old-Age Pensions Act 1908 provided an "Invalid Pension" to people "permanently incapacitated for work" and unable to be supported by their families, so long as they fulfilled racial and other requirements. This provided money that recipients could spend on their care and assistance.
In 1941, the "Vocational Training Scheme for Invalid Pensioners" was begun by the Curtin government. This provided occupational therapy and allied services to people who were not permanently incapacitated, to help them gain employment. In 1948, this body became the Commonwealth Rehabilitation Service, and its work continued.
In the 1970s, care of people with severe disability in Australia shifted from institutionalisation, to being cared for in the community. In 1974, Gough Whitlam proposed a national disability insurance scheme like the scheme created in New Zealand that year. Academic Donna McDonald suggests it was Treasurer Bill Hayden who convinced Whitlam to focus on the introduction of Medibank, the predecessor to Medicare, instead.
In 1991, the Disability Support Pension replaced the Invalid Pension, with the aim of increasing recipients' rehabilitation and hours of paid work.
In 2005, the NSW government created the Lifetime Care and Support Scheme, to cover ongoing care for people who had been severely injured in motor accidents.
In 2006, Bruce Bonyhady, chair of Yooralla, met with former Labor cabinet minister Brian Howe, who put him in touch with a group of people who became known as the Disability Investment Group. In 2008, the Disability Investment Group made an independent submission to the Australia 2020 Summit. They then sent their recommendations to the Productivity Commission.
In 2011, the Productivity Commission released a report on the issue. Disability in Australia "was framed as an economic issue, rather than a social issue". Research by PricewaterhouseCoopers in 2011 found that by approximately 2025, the cost of maintaining the status quo in relation to the care of people with a disability, would be greater than the cost of an NDIS. In 2011, the Council of Australian Governments agreed the disability sector in Australia needed reform.
In 2011, it was recommended that psychosocial disability be included in the scheme. Due to the mental health sector's use of the recovery approach rather than a focus on permanent disability, this has been a culture clash.
According to a report from the Australian Institute of Health and Welfare in September 2012, demand for disability aid in Australia had seen significant increases in recent years.
Establishment of a NDIS trial
In November 2012, a bill to establish the NDIS was introduced into Federal Parliament by Prime Minister Julia Gillard. In March 2013, it was passed as the National Disability Insurance Scheme Act 2013. There is a COAG Disability Reform Council which continues to oversee the NDIS.When the Abbott government came into power in 2013, the assistant minister in charge of the NDIS was Mitch Fifield, who capped the number of employees the NDIA could have to 3,000, when the Productivity Commission had estimated 10,000.
The 2013 Australian federal budget committed $14.3 billion to the NDIS, to be paid for by increasing the Medicare levy by 0.5%. In May 2013, the Australian Government estimated that the disability sector in Australia would need to double to meet the needs of the NDIS.
The first part of the scheme rolled out on 1 July 2013. It was initially known as "DisabilityCare Australia" and commenced only in South Australia, Tasmania, the Hunter Region in New South Wales and the Barwon region of Victoria. The NDIS began in the Australian Capital Territory in July 2014. The Medicare levy increased from 1.5% to 2% on 1 July 2014, to fund the NDIS.
In the first nine months of the scheme, 5,400 people with disabilities accessed an NDIS plan.
Between 2014 and May 2015, a project entitled the National Disability Insurance Scheme Citizens’ Jury Scorecard was led by People With Disability Australia, in collaboration with Max Hardy Consulting, with the support of the National Disability Insurance Agency. This involved twelve Australians, including people with disability, being randomly selected to serve as nonspecialist jurors, with the role of determining to what extent the NDIS was achieving its stated vision and aspirations.
In February 2015, the government disability rehabilitation and employment body CRS Australia was abolished, with its functions being distributed via the NDIS and Disability Employment Services markets.
In late 2015, the Abbott government began a process of making significant changes to the board of the NDIA. Current board directors, including then board chair Bruce Bonyhady, claimed their positions were advertised publicly before they were informed. In October 2016, Minister for Social Services Christian Porter, announced his intention to appoint several new board members, including a new chair. The primary experience of the newly appointed members were in corporate sectors, including "financial services, health, energy, resources, education and arts sectors", rather than the previous board member's disability sector experience. The new board appointees, including incumbent chairwoman Dr Helen Nugent, were announced in January 2017.
The 2016 Australian federal budget attempted to make savings of $2.1 billion for the NDIS fund by re-assessing Disability Support Pension recipients' capacity to work, and cutting compensation for the carbon pricing scheme. This included scrapping an ad campaign letting people know about the NDIS. This budget committed to reduce the number of permanent employees in the NDIA to 3,000. Peak disability group People with Disability Australia expressed concerns the NDIS would become a 'political football'.
Transition to national operations
The NDIS began formally rolling out on 1 July 2016. NDIS CEO, David Bowen, announced his resignation in March 2017, which took effect in November 2017. He was replaced with former Bankwest CEO, Rob De Luca.In February 2017, the NDIS was developing a virtual assistant called "Nadia" which takes the form of an avatar using the voice of actress Cate Blanchett.
In April 2018, the NDIA announced that Serco would be operating contact centres in Melbourne and regional Victoria for two years. This prompted concern from peak advocacy body People with Disability Australia and others about Serco's lack of experience with disabilities despite being at the first point of contact with clients.
In May 2018, the Australian Financial Review noted that the NDIS was "becoming an economic factor in its own right", particularly in regional areas.
A May 2018 report by Flinders University into the running of the NDIS found that half of all participants in the NDIS have either had their support reduced, or have not experienced a change in their support levels since the NDIS has been introduced.
In 2018, it was reported that the NDIA had a budget of $10 million for legal services, that are employed to attempt to prevent people appealing for more money under the scheme, or to prevent them from accessing the scheme. As of May, 260 cases had been resolved by the courts, with the NDIA losing 40% of them.
In June 2019, some 298,816 people with disabilities were being supported by the NDIS.
The Tune review, led by David Tune in 2019, made 29 recommendations to help the NDIS. The report was handed to the government in December 2019, and was published in January 2020.
In 2021, independent assessments were to be introduced for NDIS participants over the age of 7. The independent assessments will focus on "individual circumstances and functional capacity". Assessors will be qualified health professionals who are not NDIA employees, and they cannot be a participant's regular healthcare professional. Assessments will take 1 to 4 hours, and the assessors will "ask you questions about your life and what matters to you, and ask to see how you approach some everyday tasks. They will work through some standardised assessment tools with you, based on your age or disability".
Disability advocates are concerned about the introduction of independent assessments, and the NDIA has explicitly linked the introduction of independent assessments to containing the cost of the NDIS. While the Coalition government is committed to introducing independent assessments, they do not enjoy parliamentary support. Following a lobbying campaign by disability coalition Every Australian Counts a trial scheme for independent assessments was put on hold in April 2021. Further campaigning saw them fully abandoned in July 2021.
In April 2022, around 85% of people with disabilities in Australia were not covered by the NDIS. It served just over 518,000 people out of an estimated 4.4 million Australians living with disability. Experts interviewed by the ABC suggested that this was in part because people aged over 65 are not eligible for NDIS supports, and that some lesser-visible disabilities were harder to establish eligibility for.
In August 2024, a series of NDIS reforms were passed, slated to reduce NDIS spending by $14 billion over the following four years. The reforms included moving foundational disability supports to the states and out of the NDIS, tightening eligibility rules for some supports, and setting an annual spending growth target of 8%.