Multiple sources of funds
The settings pathways range from acute hospital care to living in the community.
Brain injury specialist rehabilitation may also be episodic, as new situations and opportunities arise.
In addition to the funds provided for health services there are multiple sources of funds that the person may potentially be able to access to pay for the services and supports they require for rehabilitation and living independently in the community including disability, motor vehicle and other insurance funds.
One person can have multiple funding pathways, a person can be eligible for the National Disability Insurance Scheme, be receiving a workers compensation payment and have private disability insurance. Table 5 provides some of the more common funding pathways in NSW.
Key question
For each person with a serious brain injury the key question is
What is the insurance status of the injury event and the person's age at the time of the injury and the implications of this?
Criteria
The insurance status and age at the injury event will determine what sources of funds the person is entitled to. Many injury events are covered by insurance, for example:
- workers compensation
- insurance policies such as income insurance, disability insurance, public liability insurance
- motor vehicle accident insurance.
Funding sources
If the injury event is covered by insurance the person may be entitled to insurance payouts from the relevant insurance.
Irrespective of these insurance payouts people may be eligible to apply to the NDIS and commonwealth governments aged care programs including the Commonwealth Home Support Program.
If the age at injury is less than 65 the NDIS applies. If the age at injury is 65 or more the aged care programs apply.
The payments and services provided through the NDIS and aged care programs may be adjusted where the injury event is specifically insured and there are insurance payouts to the person with the ABI.
| Insurance status | Criteria | Agency | Service management |
|---|---|---|---|
| Uninsured event | Under 65 | NDIS | The agencies determine the eligibility, funding and appropriate service providers resulting in services that are managed in one of these ways.
|
Over 65 or over 50 years for Aboriginal and Torres Strain Islander people | Aged care | ||
| Insured event or part of event | Workers compensation | icare | |
Other insurance | Private insurance company | ||
Motor vehicle accident | icare |
* Serious brain injury is brain injury that may be appropriate for brain injury specialist rehabilitation
Funding criteria questions
To achieve the best outcomes for the person’s rehabilitation, once the insurance status of the injury and age at injury is determined, answers are required for the following questions.
- What are the agencies involved? For each agency involved:
- What are the eligibility criteria? Each agency has its own eligibility criteria.
- What will the funding be based on? Each agency has its own criteria.
- Who provides the funded services? Each agency has its own criteria.
- How are services managed? Self-managing and managed by service providers.
Case management is often part of how these questions are answered in each particular case.
Agency questions
Key questions for brain injury specialist rehabilitation services and each funding agency, e.g. NDIS, icare, Aged Care.
- Where are the boundaries between brain injury specialist rehabilitation and the agency?
- How are these boundaries managed?
- What’s required in the best interests of the clients?