What the NDIS is, and who it is for
The National Disability Insurance Scheme (NDIS) provides funding and support to Australians who have a permanent and significant disability. It is run by the National Disability Insurance Agency (NDIA), with quality and safety of providers overseen separately by the NDIS Quality and Safeguards Commission.
The NDIS is not the same as Centrelink payments or aged care. It is designed to fund the supports and services a person needs because of their disability, so they can do everyday activities, work towards their goals and take part in their community. It is not means tested, so your income and assets do not affect whether you can access it or how much funding you receive.
There are two main pathways into the scheme. Most adults apply on the basis of the disability requirements, while young children with developmental concerns are usually supported first through the early childhood approach. Whichever pathway applies to you, the eligibility rules are set out in the National Disability Insurance Scheme Act 2013 and are the same for everyone who applies.
This guide explains the eligibility rules and the application process in plain English. Because some details (such as forms, indexed support prices and operational guidelines) are updated regularly, always confirm the current detail on the official ndis.gov.au pages linked throughout.
Source: www.ndis.gov.au
The four eligibility requirements at a glance
To become an NDIS participant you need to meet the access criteria. There are four requirements the NDIA must consider, and you need to satisfy the age and residency requirements plus either the disability requirements or the early intervention requirements.
The four requirements are:
- Age: you must be under 65 at the time you apply.
- Residency: you must live in Australia and be an Australian citizen, a permanent visa holder, or a Protected Special Category Visa holder.
- Disability: you have a permanent impairment that substantially reduces your ability to do everyday activities, or
- Early intervention: getting support now would reduce how much support you are likely to need in future (this is the common pathway for young children).
You only need to meet the disability requirements OR the early intervention requirements, not both. The age and residency requirements, however, apply to everyone.
Before you apply, you can use the official eligibility checklist on the NDIS website to get an idea of whether you are likely to meet the requirements. The checklist is a guide only and does not replace a formal decision by the NDIA.
Source: www.ndis.gov.au
Age and residency: the rules that apply to everyone
You must be under 65 when you make your Access Request. If you are 65 or over, you are generally supported through the aged care system instead. People who were already NDIS participants before turning 65 can usually choose to stay on the scheme, but you cannot make a new Access Request once you have reached 65.
For residency, Australia must be your home and you must spend most of your time here. You also need to be one of the following: an Australian citizen, the holder of a permanent visa, or a holder of a Protected Special Category Visa (a category that applies to certain New Zealand citizens who were in Australia on a particular date). People here on temporary or other visa types are generally not eligible.
The NDIA can confirm your residency status from your Centrelink record if you give consent. If you do not consent, you will need to provide a document showing when you were born or arrived in Australia, such as a full birth certificate, passport or Australian Citizenship Certificate.
Once you are a participant, you can travel overseas and still use your NDIS supports for up to 6 weeks. If you are overseas for longer than 6 weeks, you generally cannot use your NDIS funding unless the NDIA has given approval. Confirm the current rules at the official source before travelling.
Source: www.ndis.gov.au
The disability requirements: permanent impairment and functional impact
This is the main pathway for adults and older children. To meet the disability requirements, your disability must be caused by an impairment that is permanent, meaning it has not been, and is unlikely to be, substantially improved by conventional treatment. The NDIA looks for evidence that you are likely to have the impairment for life. It is fine if the impact varies, gets better and worse, or comes in episodes (as is common with psychosocial disability).
Your impairment must also substantially reduce your functional capacity, which means that on most days it significantly limits your ability to manage ordinary daily activities in one or more of six areas. These are sometimes called the functional domains:
- Mobility (moving around your home and community)
- Communication (being understood and understanding others)
- Social interaction (making and keeping relationships, behaving within limits accepted by others)
- Learning (understanding and remembering information, learning new things)
- Self-care (showering, dressing, eating, managing your health)
- Self-management (organising your life, making decisions, managing money and tasks)
A diagnosis on its own is not always enough. The NDIA refers to two lists in its guidelines. List A sets out conditions that are likely to meet the disability requirements largely on the basis of diagnosis. List B sets out permanent conditions where functional capacity varies, so you will usually need to provide further evidence of how the impairment affects your daily life. If your condition is on List B, having the diagnosis helps establish permanence, but you still need to show substantial functional impact.
You also need to show you are likely to need NDIS supports for your lifetime. Confirm which list a condition appears on, and the current wording of the requirements, in the official Our Guidelines pages, as these are reviewed regularly.
Source: www.ndis.gov.au
The early intervention pathway and the early childhood approach
The early intervention pathway is for people who would benefit now from supports that reduce how much help they are likely to need in future. It is the common route for young children, but it can also apply to adults whose early support would lessen the future impact of their impairment.
For children, the early childhood approach is the starting point. Children younger than 9 with developmental concerns or disability, and their families, can get help through an early childhood partner. For very young children, you do not always need to apply formally to the NDIS first: an early childhood partner can connect families to supports straight away.
There is an important age distinction. To meet the NDIS early intervention requirements specifically because of developmental delay, a child must be younger than 6, and importantly they do not need a formal diagnosis for this pathway. Children aged 6 and over, or children whose situation does not fit developmental delay, are assessed against the standard disability or early intervention requirements, which may involve providing a diagnosis and evidence.
The early childhood approach has been progressively expanded so that early childhood partners support children younger than 9, which helps families during and after the move into primary school. Because age rules and processes in this space have changed in recent years, check the current detail on the NDIS early childhood pages before relying on a specific age cut-off.
Source: www.ndis.gov.au
How to apply: making an Access Request, step by step
Applying to the NDIS is free. The application is called an Access Request, and there are a few ways to make one:
- By phone: call the NDIA on 1800 800 110 and ask to make a Telephone Access Request. The staff member completes the form with you over the phone.
- By form: download the Access Request Form from ndis.gov.au, complete it, and email it to [email protected] or post it to GPO Box 700, Canberra ACT 2601.
- In person: hand your completed form to your local NDIS office or partner (an early childhood partner or a Local Area Coordinator).
A practical step order looks like this:
- Step 1: check the eligibility checklist on the NDIS website so you know which requirements you need to address.
- Step 2: gather your supporting evidence, especially evidence of your disability and its functional impact from your treating professionals.
- Step 3: make your Access Request by phone or by submitting the form.
- Step 4: provide consent for the NDIA to confirm your age and residency (for example from your Centrelink record), or supply the documents yourself.
- Step 5: wait for the decision. Once the NDIA has your complete application and all supporting evidence, it must tell you whether you are eligible within 21 days.
If you need help at any stage, a Local Area Coordinator or early childhood partner can explain the process and the evidence required, free of charge. Independent advocacy services can also support you, particularly if you need help putting your application together or challenging a decision.
Source: www.ndis.gov.au
Supporting evidence: what to provide and from whom
The single most important part of your application is the supporting evidence about your disability and how it affects your daily life. Weak or incomplete evidence is one of the most common reasons applications are delayed or knocked back.
Good evidence usually comes from a treating professional who knows you well, such as your GP, specialist, paediatrician, psychologist, psychiatrist, occupational therapist or other allied health professional. The NDIS provides an Access Request Supporting Evidence Form that your treating professional can complete to describe your impairment.
Strong evidence does more than name a diagnosis. It should describe:
- What your condition or impairment is, and that it is permanent or likely to be lifelong.
- The tasks you can do without help, and the tasks you need support, aids or equipment to do.
- Clear, specific examples of how your impairment limits everyday activities, at home, at work and in the community.
- What supports, aids or equipment you already use or need.
There is no fixed limit on how recent the evidence must be, but it should reflect your current situation. If you do not have suitable recent reports, talk to your treating professional early, as gathering quality evidence can take time. Some assessments or reports may carry a fee charged by the professional, so check costs with them in advance; the NDIS Access Request itself is free.
Source: www.ndis.gov.au
After you are found eligible: your plan, and choosing providers
If the NDIA decides you are eligible, you become an NDIS participant and the next step is creating your first plan. You will have a planning conversation (a plan meeting) with an NDIA planner, Local Area Coordinator or early childhood partner, where you talk about your goals, your current supports and what you need. It helps to think about your goals beforehand.
Once your plan is approved it appears in the my NDIS portal and app, and you can begin using your funded supports. If you would like one, you can be offered a plan implementation meeting, usually arranged within 7 days of approval, to help you understand how to put your plan into action. Some plans include funding for support coordination to help you find and connect with providers.
Being on the NDIS and choosing your providers are two separate things. You generally have choice and control over who delivers your supports. Some participants must use NDIS registered providers (for example, depending on how your plan is managed), while others can also use unregistered providers. Check how your plan is managed to understand your options.
Before you commit to a provider, you can check whether they are registered, suspended or have had compliance action taken against them on the NDIS Commission Provider Register. Comparing providers on price, services, location and track record is sensible. This site helps you do exactly that, independently, once you are ready.
Source: www.ndis.gov.au