Tara Lama posted 2 weeks ago

Does NDIS Cover Dental?

ndis dental coverage

Does NDIS Cover Dental?

The National Disability Insurance Scheme (NDIS) is a government-funded program designed to provide support and services to individuals with permanent and significant disabilities. While the NDIS covers a wide range of supports, the inclusion of dental services is somewhat complicated and subject to specific eligibility criteria.

Eligibility Criteria for Dental Funding under NDIS

The NDIS may cover dental services if they are considered reasonable and necessary for the participant’s disability-related needs. The eligibility criteria for dental funding under the NDIS are as follows:
Disability-Related Dental Needs: The dental treatment or service must be directly related to the participant’s disability. This could include dental issues arising from the disability itself or the side effects of medications used to manage the disability.
Reasonable and Necessary: The dental treatment or service must be considered reasonable and necessary to support the participant’s daily living activities, social and economic participation, or overall well-being.
Permanent and Significant Disability: The participant must have a permanent and significant disability that substantially reduces their functional capacity in one or more areas of daily living, such as communication, mobility, self-care, or self-management.
Age Eligibility: The participant must be under the age of 65 at the time of applying for the NDIS. However, if the participant was already receiving NDIS support before turning 65, they may continue to receive funding for dental services.
It’s important to note that the NDIS does not cover routine dental check-ups, cleanings, or general dental treatments that are not directly related to the participant’s disability. These services are typically covered by Medicare or private health insurance.

The Process of Obtaining Dental Funding under NDIS

The process of obtaining dental funding under the NDIS can be somewhat complicated and may involve several steps:
Preparing Evidence: The participant or their representative will need to gather relevant medical reports, assessments, and other documentation that demonstrate the disability-related dental needs and the necessity of the requested treatment or service.
Submitting a Request: The participant or their representative will need to submit a request for dental funding as part of their NDIS plan review or plan implementation process. This request should include the supporting evidence and a detailed explanation of how the dental treatment or service relates to the participant’s disability-related needs.
Assessment and Approval: The NDIS will assess the request based on the provided evidence and the eligibility criteria. If approved, the dental treatment or service will be included in the participant’s NDIS plan, and funding will be allocated accordingly.
Finding a Provider: The participant will need to find a dental provider who is registered with the NDIS and willing to accept NDIS funding for the approved treatment or service.
Claiming and Payment: The participant or their representative will need to follow the NDIS claiming process to receive reimbursement for the approved dental treatment or service.

It’s important to note that the approval process for dental funding under the NDIS can be complex and may require significant documentation and advocacy. Participants or their representatives may benefit from seeking assistance from disability support organisations or advocacy groups to navigate the process effectively.

More indepth information about the intricacies of NDIS dental coverage can be found at Carelogy’s recent post.