NDIS Complex Care: A Complete Guide to Funding & Support

Getting complex care funding through the NDIS can be confusing. If you need high-intensity support, understanding the NDIS is essential.

People often struggle with:

• Understanding their eligibility requirements- Who can get money for complex care by NDIS?
• How to apply for a medical document?
• Good Provider- How do you choose a provider that suits your needs?
• Maximizing NDIS funding- by what means does it ensure that you maximize support?

This guide makes it easy to take charge of your NDIS plan and get the care you need.

What Does Complex Care Mean?

Complex care supports people with severe disabilities, chronic conditions, or complex health needs.

It provides more than basic care, with nurses, therapists, and support professionals.

Who Are Candidates for Complex Care?

Complex care supports individuals with:

• Neurological disorders (like cerebral palsy, many sclerosis, and Parkinson’s disease);
• Severe physical disabilities (such as spinal cord injury, amputation, and muscular dystrophy)
• Chronic illnesses, for example, complications from diabetes, respiratory diseases, and severe arthritis.
• Mental health conditions requiring high-support care, such as schizophrenia and severe anxiety disorders.

The key distinctions between complex care and standard NDIS care are as follows:

• 24/7 care or overnight support for high-needs individuals.
• Medication management and wound care delivered by professionals.
• Behavioral care for autism, ADHD, and psychiatric conditions.
• Equipment and home modifications that improve function and quality of life.

Does NDIS fund the Complex Care?

Yes! NDIS funds Complex care but you must be aware of the eligibility criteria.

Who is eligible?

To qualify for complex care under the NDIS, you must meet these requirements:

• The applicant must have a permanent impairment that limits daily activities.
• They must need high-intensity support like medication management, continence care, or mobility help.
• The applicant must have applied for the NDIS before they turn 65 years old.

What NDIS Complex Care Covers?

The NDIS funds daily high-intensity care like PEG feeding, catheter, and wound care.

Caregivers provide 24/7 support for people who need supervision.

Live-in support workers offer night care, mobility help, medical support, and personal care.

The other segment for the NDIS would be community and social support. Funds outings, activities, and events that promote independence and social connection with support.

The NDIS provides behavioural support for emotional or behavioural disabilities.

Psychologists, therapists, and support workers help address complex behavioural and emotional needs.

Assistive tech and home mods like wheelchairs and ramps improve mobility and safety.

Many believe the NDIS won’t fund 24-hour support, but the right medical evidence can secure it.

How to Apply for Complex Care Funding

Getting complex care funding requires thorough documentation. Here are the steps:

Step 1: Collect Medical Evidence

A strong NDIS application needs solid medical evidence. This evidence shows why you need complex care and helps you get approved.

Specialists’ reports explain your condition and why you need specialized care.

Physiotherapists, occupational therapists, and speech therapists provide supporting evidence.

These assessments would further explain ticket issues, communication issues, or rehabilitation needs.

Finally, keep daily logs of subsistence care. This should show daily support needs, like bathing, walking help, or medication management.

Medical evidence of such a standard is key if you are to get proper funding. The more exhaustive the diary you keep, the better your chances of getting the support you need.

Step 2: Submit Your NDIS Plan Application

If it's your 2nd time applying, submit an NDIS access request online or call the NDIS helpline. Or, visit an NDIS local area coordinator(LAC) who will help you fill out your application.

If you already have an existing NDIS plan you will not need to make a new application. Your plan review request can include complex care support. But, you must submit a Change of Circumstances form with updated medical evidence.

For the best results, explain why standard NDIS supports are not enough. Describe your care needs and how extra funding will improve your life.

Step 3: Prepare for the NDIS Planning Meeting

Preparation will guarantee that you get the right support.

At the meeting, explain why general care isn’t enough.

Point out your daily struggles and tasks you cannot perform without help. Be exhaustive and provide practical examples.

Emphasize the need for specialized carers or support around the clock. If you need 24/7 care, explain why intermittent support isn’t enough.

Explain why you need trained professionals for wound care, medication, and behavioural support.

Discuss any essential equipment or home modifications for your safety and independence.

If you need a wheelchair, hoist, ramp, or special bed, show medical recommendations.

Good preparation improves your chances of getting the right funding. Ensure you have documented evidence for everything you need.

Step 4: Appeal if they deny the change.

If the NDIS denies your request, don’t give up! You can appeal and ask for a review.

Make an internal review request within 90 days of receiving your plan. This allows the NDIS to assess your application again. Be very explicit in saying why you consider changes in the decision.

In strengthening your case, submit any further medical evidence if necessary.  Ask your doctors for updated reports on why you need complex care.

More detailed reports equal a higher chance of approval.

If denied, appeal to the AAT to overturn the decision.

The process takes time and effort, but many get the support they need after a review or hearing.

Be persistent if this becomes necessary, and seek expert help.

Common Mistakes to Avoid in Your Application

Many simple mistakes delay or halt an approval for an NDIS application. Stop these errors to enhance your acceptance chances.

One big mistake is insufficient medical evidence. A short note from a doctor is not good enough.

Submit reports from your neurologist, physiotherapist, or other specialists.

These reports should explain your condition, daily challenges, and need for complex care.

More evidence makes your case stronger.

Another big mistake is underestimating support. Some applicants downplay their needs in fear of “asking for too much.” This usually leads to underfunding. Speak about the level of care you need. If you need 24/7 support or specialist care, you need to justify this in your application.

Many people don't think about their plans every year either. Where the needs change, the funding also should. If you need more support or different equipment or therapies, request a plan review. By doing so, you ensure that the funds under your NDIS plan currently meet your needs.

These mistakes can keep you from getting the right support without delay.

Choosing the Right Complex Care Provider

Provider support varies, so make a careful choice.

Verify the provider’s NDIS registration.

Registered providers follow strict standards, get audited often, and ensure safe care.

Experience is important. You should choose a provider with a good track record in providing complex care. Client reviews and testimonials are an excellent starting point. Search for providers that have cared for people with similar needs to those you have.

Personalized care is imperative. The best providers will develop individualized care plans based on your unique needs. They must listen to your concerns and change support.

Avoid providers with hidden fees, high staff turnover, and poor communication.

Such factors create a setup for inconsistent care and frustrations.

Before agreeing, ask for a detailed cost and service breakdown.

The right provider offers reliable, high-quality care that meets your needs.

Self-Managed vs. Plan-Managed Funding

How you manage your NDIS funding affects your complex care services.

Under NDIS, you have two options: self-managed or plan-managed funding.

With self-managed funding, you manage your budget. You choose your service providers and negotiate the prices for their services. This means more paperwork – you’ll need to track spending and submit invoices.

With plan-managed funding, a registered NDIS plan manager handles payments on your behalf. They pay the providers, manage invoicing, and keep track of how you spend your budget. This allows you to focus more on service delivery and be flexible in choosing providers.

Pro Tip: Want more choice in providers without the hassle of managing finances? Go for plan-managed funding!

Maximize your NDIS plan for Advanced Care.

Good management of the NDIS plan will contribute to optimal support.

Needs change, so it’s best to adjust funding as needed.

If the illness worsens or needs extra support, request a review of the plan. This affords alternative funding and access to other services.

There is also some extra supplementation.

If your plan lacks therapy, equipment, or tech, talk to your provider or NDIS planner.

Make sure your plan meets all your needs before choosing a provider.

Do not feel bad if the current provider does not keep the end of the bargain about the quality of care. If a provider’s services don’t meet your needs, switch. The NDIS allows full flexibility in choosing providers.

With these steps, you will receive the best possible level of care and maximize your NDIS funding.