Understanding the Relationship Between NDIS and Mainstream Services

Introduction

The National Disability Insurance Scheme (NDIS) funds disability-specific, individualised supports for eligible Australians. “Mainstream services” are the universal systems everyone uses—health, education, housing, justice, transport, employment, etc.

To get real outcomes, these systems must work as one connected ecosystem, not pass the buck. The formal rulebook for who does what is the Applied Principles and Tables of Support (APTOS), agreed by all governments, and the NDIA’s operational guidelines. Learn them and you’ll stop 80% of the ping-pong. Australian Department of HealthOur Guidelines

What Are Mainstream Services?

Mainstream services are publicly funded systems available to all Australians. Examples:

• Healthcare: hospitals, GPs, mental health, rehab.

• Education: early childhood, schools, TAFE/universities, reasonable adjustments.

• Housing: public/social housing, homelessness services.

• Employment: Workforce Australia, fair work protections, workplace adjustments.APTOS sets the high-level split across these systems; NDIA guidelines give day-to-day decision criteria. Australian Department of HealthOur Guidelines

  
  

How NDIS Supports Mainstream Services

NDIS plugs disability-specific gaps that mainstream doesn’t cover. Think “complement, not duplicate.” Typical patterns:

• Health: Health system pays for diagnosis, treatment, hospital care, MBS/PBS items. NDIS may fund supports that relate to functional capacity—e.g., communication aids, home modifications, disability-related consumables, and support workers to help hospital staff understand a person’s communication device. NDISOur Guidelines

• Education: Schools must deliver curriculum and reasonable adjustments (e.g., teacher aides, classroom adjustments). NDIS may fund disability-specific supports around school (e.g., specialist behaviour support; training for teachers about a student’s disability). Queensland EducationNDISOur Guidelines

• Employment: Mainstream employment services and employers handle job search and workplace adjustments; NDIS can fund capacity-building (e.g., job coaching tied to disability needs). Australian Department of Health

Key Differences—And How They Complement

• NDIS: Individualised, disability-specific, “reasonable and necessary,” value-for-money tests, and must not fund what another system is responsible for. NDISOur Guidelines

• Mainstream: Universal access obligations and anti-discrimination duties (e.g., reasonable adjustments in education and employment). APTOS is explicit: responsibilities shouldn’t fall through the cracks—no wrong door. Australian Department of Health

How to Access Both—A Pragmatic Playbook

1. Map the support to the system

   • If it’s clinical care, meds, hospital, rehab → Health.

   • If it’s curriculum, teacher aides, school adjustments → Education.

   • If it’s disability-specific equipment, therapy for functional goals, daily living supports → NDIS (subject to R&N). NDISQueensland EducationOur Guidelines

2. Use APTOS as your escalation leverQuote the relevant APTOS table when agencies bounce you around. It’s the intergovernmental contract line managers recognise. Australian Department of Health

3. Work with your NDIS planner/partnerThey must ensure NDIS supports don’t duplicate mainstream and can fund complementary items (e.g., training school staff about your device). Our Guidelines+1

4. Leverage Navigators (the new reform)The NDIS Review recommends local Navigators to connect you with foundational, mainstream and NDIS supports. This is being co-designed now—use it as it lands. NDIS ReviewNDIS

5. Document everythingKeep letters from schools/health, itemised quotes, and functional assessments that link the request to disability needs (this is how you win R&N arguments). Our Guidelines

Real-World Examples

• Wheelchair vs. Wards: Public hospital treats pressure sores; NDIS funds the power chair and pressure-care cushion that prevent decline at home. NDIS

• School Support: The school provides the teacher aide and classroom adjustments; NDIS funds behaviour support planning and training for staff about a student’s specific communication or sensory profile. Queensland EducationOur Guidelines

Challenges (Let’s call them out)

• Buck-passing: Agencies still “hand-ball” costs. APTOS exists, but frontline compliance is patchy. Use the written principles and escalate. Australian Department of Health

• Hospital discharge delays: Interface failures strand people in beds. This is a live pressure point across jurisdictions—coordination must tighten. The Daily Telegraph

• Information asymmetry: Families don’t know where lines are drawn; providers don’t always train staff on the interface. APPA

Solutions (Play offense, not defense)

• Quote chapter and verse: Cite APTOS and the NDIA “Mainstream and community supports” guideline in emails and case conferences. It changes conversations. Australian Department of HealthOur Guidelines

• Define outcomes, not widgets: Frame requests around functional outcomes linked to goals (mobility, communication, participation). That’s how the R&N test is applied. Our Guidelines

• Use Navigators and structured escalation: As navigator roles roll out, route complex interface issues early. If a decision contradicts APTOS/guidelines, lodge a reconsideration and, if needed, a complaint to the NDIS Quality and Safeguards Commission for provider conduct issues. NDIS

• Co-design with your school/health team: Agree a written support matrix (who funds what, timeframes, contacts) before term starts or before elective admissions. NDIS

Conclusion

NDIS and mainstream are complementary by design: mainstream handles universal obligations (treatment, teaching, housing access); NDIS funds the disability-specific supports that enable real participation. When you anchor decisions in APTOS and NDIA guidelines—and push for coordinated delivery—you get past the bureaucracy and into outcomes that actually move the needle. Australian Department of HealthOur Guidelines

Call-to-Action

Need a no-nonsense interface plan for your situation? Contact us to map responsibilities, script your APTOS-backed requests, and de-risk your next plan meeting. Want to lift the system for everyone? Join our advocacy network pushing for clean interfaces, timely hospital discharges, and Navigator rollout that actually works on the ground. NDIS ReviewNDISThe Daily Telegraph

Quick Reference (keep this handy)

• Rulebook: APTOS (who funds what, by sector). Australian Department of Health

• NDIA guideline: Mainstream & community supports (operational decisions, examples). Our Guidelines

• Health boundary: NDIS doesn’t fund diagnosis/treatment, MBS/PBS, hospital care. NDIS

• School boundary: Schools provide teacher aides and adjustments; NDIS may fund disability-specific supports/training. Queensland EducationOur Guidelines

• Reform horizon: Navigators + foundational supports to stitch the system together. NDIS Review