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Gym memberships on NDIS?

The NDIA don’t make funding gym and exercise supports easy, find out what the AAT has to say about that.

By Chris Coombes

Updated 15 Apr 20241 Feb 2022

Recently, DSC released a piece titled ‘We Wouldn’t Fund It’ busting 31 myths about supports that people claim the NDIA does not fund. Today we dive deep into one of those supports, with a focus on exercise and gym memberships.

Just thinking about exercise in public makes me sweat. The mirrors are creepy, and the spaces have all sorts of funky smells. Take a Pilates class, for example. Ninety percent of the sweating in the Downward Dog comes from trying not to add to that funky smell. These are good reasons why someone might not ask for funding for exercise supports in their NDIS plan.

On the positive side however, exercise supports are valuable for building muscle tone, flexibility and mental stamina. They can improve our well-being and performance at work. Going to the gym draws us into the community, so funding exercise supports is a great investment for a Scheme tasked with enhancing social and economic participation.

So why are the NDIA jerks when it comes to funding exercise supports?

In fairness, the NDIA does fund some exercise supports. Access to supports like exercise physiology is much more common. But participants often need to drag the NDIA through the Administrative Appeals Tribunal (AAT) to get funding for less common supports, such as gym memberships, yoga, dance classes, Pilates and personal training. If the thought of preparing for yet another review leaves you hot and sweaty, maybe you won’t need that gym membership after all!

Here’s a list linking you to the exercise-related supports that the AAT directed the NDIA to fund:

Myth 1

NDIS doesn’t fund Gym membership

Matter King and Milburn

Year 2015 and 2018

Status Busted

 

Myth 2

NDIS doesn’t fund Taxi fares to and from the gym

Matter Perosh

Year 2018

Status Busted

 

Myth 3

NDIS doesn’t fund Personal training

Matter Milburn

Year 2018

Status Busted

 

Myth 4

NDIS doesn’t fund Dance classes  

Matter QXDY and Young

Year 2020

Status Busted

 

Myth 5

NDIS doesn’t fund Trial of one alternative therapy, including

-           Yoga

-           Pilates Young

Matter Young

Year 2021

Status Busted

 

Myth 6

NDIS doesn’t fund Aeroplane tickets for carer to travel with participant twice a year for competitive sport

Matter David

Year 2018

Status Busted

NDIS and Gym Membership

The NDIS has developed a Would We Fund It? resource for gym memberships (2021). ‘Suresh’ and ‘Sue’ in the NDIS’s case examples are seeking funding for gym memberships.

The NDIS rejected both requests for the following reasons:

  • Gym membership is a day-to-day living expense.
  • The gym membership was not directly related to their disabilities.

Creating a ‘resource’ for participants with only examples of gym funding being rejected is cheeky. It’s even more naughty given that the AAT has twice found gym memberships to be reasonable and necessary (in both King 2015 and Milbourn 2018 vs NDIA).

So how does the NDIA keep saying ‘No’?

Given the past AAT rulings, how does the NDIA keep turning down funding for gym memberships? We will look at some of the common justifications the Agency has come up with and how you might rebut them. Be sure to have reports that address all parts of the legislation and the Rules that the NDIA can use to reject fringe supports. I’ve provided some general tips and ideas below to address some of the common issues; however, it’s by no means a complete checklist.

Day-to-Day Living Expenses – Rule 5.1(d)

Arguing that exercise supports are day-to-day living expenses is the oldest trick in the book. But in Milburn vs NDIA 2018, the respected Deputy President Constance who threw out this argument explained:

I have considered the […] rule that a support will not be funded if it relates to ‘day-to-day’ living costs. I note the examples given of rent, groceries and utility fees. While these are only examples, they are indicative of the costs of living which most members of the community incur in one form or another. The same cannot be said of gym membership fees. While the Agency may be correct in saying that many people engage in fitness activities at a gym, it does not follow that the costs of gym membership ‘relate to day-to-day living costs’. In my view, it is in the nature of discretionary spending for those who do not suffer [sic] from a disability. […] I am satisfied that, in Ms Milburn’s case, it is attributable to her support needs.

In short, disabled people don’t always get the choice to not buy things like gym memberships, so it’s not a day-to-day living expense.

Value for Money – s34(1)c of the NDIS Act

After the everyday expenses argument falls apart, ‘value for money’ is another common tool in the NDIA’s ‘No’ shed. Reports should detail (a) the value of the support, (b) how a gym membership will save the NDIA money in the long run. You may wish to include a written statement describing the value this support adds as well as two to three quotes for gym memberships in the area with an explanation of why the one selected is the most cost-effective option. Is it likely to reduce physio needs in the future? Say that and show them your math. Demonstrate how a weekly gym membership at the person’s sister’s gym (she transports them anyway) is actually cheaper than paying a support worker to take a walk with them. Where will it save the government money?

Effective and beneficial – s34(1)d of the NDIS Act

The NDIA may need more evidence that the gym will have the benefits you say it will. An exercise physiologist, OT or physio could provide a functional assessment report describing function and whether/how gym attendance would be of benefit. It could describe which contexts (e.g. a gym) and activities (e.g. personal training) would safely allow the person to improve their function and why by pointing to evidence and best practice. The report could also outline the risky or terrible outcomes associated with using the free exercise equipment at the park – alone or with a support worker.

Responsibility of Another Service System – s34(1)f of the NDIS Act

The NDIA may say, ‘Why am I funding a gym when gym relates to managing a health condition’? Be ready to show how the support need relates to the disability.

Gym is not disability related – Rule 5.1b

The NDIS says it won’t fund a support that is not related to a disability. Because gym memberships are not day-to-day living expenses (Milburn 2018), there is no requirement for the person to prove that the need for a gym membership is ‘solely and directly’ related to their disability.

Let’s look at an example. Pretend a person has been prescribed a medication to ‘manage’ their psychosocial disability. These medications make them gain weight. In response, the GP has prescribed a gym membership. The need for gym still relates to their disability, even if it does not solely and directly relate to their disability. Regardless, the evidence you provide to the NDIA should show some link between the disability and the need for the support.

The NDIA won’t fund duplicated supports – Rule 5.1(c)

‘Why fund movement therapy classes and gym membership/physio/exercise physiology?’ the planner may ask. Each report from any exercise-y professional or an OT would do well to explain what added value the person is getting from their support. What specific functional goal does the gym relate to? How is that different from, or additional to, the function they would be building during physiotherapy, for example? A coordinated approach with your allied health team can save time and heartache here.

Two final tips

1.   The NDIS review processes can be slow and tiring. If you have the evidence that the support is reasonable and necessary and you have sufficient funds in your plan, have a conversation with your plan manager about purchasing the support. Or if you are self managed, consider purchasing the support. The checklist on page 8 of the NDIS Guide to Self Management is your best friend here.

2.   If the NDIA agrees to finally fund a hotly contested exercise support, consider asking for a longer plan – perhaps three years. This may save you collecting evidence again in 12 months’ time.

It’s not easy getting exercise supports over the line. And I don’t know why the NDIS makes us fight so hard for exercise supports when the evidence about movement is boringly uncontroversial. But if everyone involved has the spoons for it, the health and well-being benefits are waiting.

I am not a lawyer, and this is general information only. For tailored advice, please seek help from a non-legal advocate or legal aid in your state or territory.

Authors

Chris Coombes

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