NDIS Act 2013 · sections 21–25
NDIS eligibility + access: the criteria + how to apply
Eligibility is a legal test under the NDIS Act 2013 – not a clinical judgement, not a discretion. You must satisfy four criteria: age, residency, AND either disability OR early-intervention requirements. The page below walks the test in plain English, lists the evidence that actually moves applications + explains what to do if your access request is declined.
★Key takeaways
- ✓Four eligibility criteria: under 65 at first access, Australian citizen/PR/Protected SCV, AND either (a) permanent significant disability OR (b) early-intervention requirements. All under sections 21–25 of the NDIS Act 2013.
- ✓List A conditions (Down syndrome, severe cerebral palsy, total blindness, etc.) get streamlined automatic access. List B conditions (autism Level 2/3, brain injury, severe mental health) need functional capacity evidence.
- ✓Apply by phoning 1800 800 110 OR completing the Access Request Form via ndis.gov.au. Children under 7 enter through Early Childhood Partners, not the NDIA directly.
- ✓NDIA decision target: 21 days from complete evidence. Real-world timeline: 8–16 weeks for straightforward cases. Evidence bottlenecks (specialist appointments) are the main delay.
- ✓Strongest evidence: specialist diagnosis + validated functional capacity assessment + treating professional letter written with NDIS criteria in mind.
- ✓If declined: internal review within 3 months (s100), then AAT appeal, or re-apply with new evidence. Free advocacy available via disabilityadvocacyfinder.dss.gov.au.
The four criteria
Eligibility under the NDIS Act 2013
You must meet age + residency + either the disability requirements (s24) or the early intervention requirements (s25). The criteria are cumulative – you need all of (age + residency + one of the two disability pathways).
Age – under 65 at first access
NDIS Act 2013, s22
You must be under 65 years of age when you first apply for access. There is no upper-age cap on remaining in the scheme – participants who join before 65 can stay on the NDIS for life. Australians who first need disability support after 65 access the aged-care system instead (Home Care Packages, residential aged care).
Evidence: Date of birth in your access request. No separate evidence required.
Residency – Australian citizen, PR or Protected SCV holder
NDIS Act 2013, s23
You must be (a) an Australian citizen, (b) a permanent resident, or (c) a Protected Special Category Visa (SCV) holder living in Australia. New Zealand citizens on a non-protected SCV are NOT eligible. The NDIS does not currently cover temporary visa holders, even if they have a permanent disability.
Evidence: Birth certificate, passport, citizenship certificate or visa grant notice. Provided in the access request.
Disability – permanent, significant + impacts daily life
NDIS Act 2013, s24 (disability requirements)
Your impairment must be: (1) attributable to a physical, intellectual, cognitive, neurological, sensory or psychosocial impairment, (2) permanent or likely to be permanent, (3) result in substantially reduced functional capacity in one or more of communication, social interaction, learning, mobility, self-care or self-management, (4) affect your capacity for social or economic participation, and (5) require lifetime support. All five must be met.
Evidence: Diagnosis from a treating health professional (GP, specialist, psychologist) + functional capacity assessment. The NDIA also accepts a Supporting Evidence Form completed by your specialist. Some conditions are on List A (auto-eligibility) – see below.
OR – Early intervention pathway
NDIS Act 2013, s25 (early intervention requirements)
Some people access the NDIS not because they have an existing significant impairment but because early intervention now will substantially reduce future impairment. Typically children under 9, or adults with a recently-acquired condition where intervention now will materially change long-term outcomes. The test is that intervention is likely to: (1) reduce future need for support, (2) build capacity, OR (3) prevent further deterioration.
Evidence: Treating health professional report identifying the condition + the early-intervention rationale. Often used for autistic children diagnosed under 7 (entering via ECEI) or post-acquired-brain-injury adults entering rehabilitation.
Streamlined pathways
List A + List B conditions
The NDIA publishes two lists of conditions where evidence requirements are streamlined. List A: conditions almost always meeting the eligibility test – minimal additional functional evidence required. List B: conditions likely to meet eligibility when accompanied by functional capacity evidence.
List A – auto-access pathway
Conditions that almost always satisfy the disability requirements. Specialist diagnosis is typically sufficient evidence on its own.
- Down syndrome (any level)
- Cerebral palsy – moderate, severe or profound (GMFCS Level 3+)
- Profound intellectual disability (IQ <20)
- Severe intellectual disability (IQ 20–34)
- Rett syndrome (confirmed diagnosis)
- Hereditary spastic paraplegia (HSP) – moderate or severe
- Spinal muscular atrophy (Type 1, 2 or 3)
- Duchenne muscular dystrophy
- Total bilateral hearing loss (over 90 dB)
- Total blindness in both eyes
- Severe + permanent quadriplegia or paraplegia
- Permanent blindness diagnosed by an ophthalmologist
- Deafblindness – confirmed by sensory specialist
- Some types of complex multi-system disability
Not exhaustive. Full list at ndis.gov.au.
List B – likely-eligible with evidence
Conditions usually meeting eligibility when accompanied by functional capacity evidence. Detailed assessment + treating professional letter materially help.
- Autism spectrum disorder (Level 2 or 3)
- Brain injury (acquired, traumatic, stroke)
- Multiple sclerosis (significant impact)
- Mild intellectual disability (functional impact)
- Mental health conditions causing psychosocial disability
- Significant chronic conditions (with permanent functional impact)
Not exhaustive. Conditions NOT on either list still meet eligibility if criteria are met.
Step-by-step
The 5-step access process
Confirm you might be eligible
Typical: 1 day
Read the eligibility criteria + use the NDIS Eligibility Checklist at ndis.gov.au/applying-access-ndis/am-i-eligible. If you are unsure, contact your Local Area Coordinator (LAC) – they help with applications + can refer you back to the right system if NDIS is not the fit.
Submit an Access Request
Typical: 1–2 weeks (gathering evidence)
Two ways: (a) Call NDIS on 1800 800 110 + complete a verbal Access Request (NDIA documents your answers + sends a Supporting Evidence Form to your treating health professional). (b) Download + complete the Access Request Form (ndis.gov.au) + submit with evidence by email or post. Children under 7 enter via the Early Childhood approach (ECEI) – contact an Early Childhood Partner instead.
Provide evidence of disability
Typical: 2–6 weeks (depending on specialist availability)
The treating health professional completes the Supporting Evidence Form (or equivalent specialist report). The NDIA needs evidence of: diagnosis, permanence, functional capacity impact + need for support. For List A conditions, a single specialist report typically suffices. For complex or borderline cases, the NDIA may request additional functional capacity assessment.
NDIA assessment + decision
Typical: ~21 days target
The NDIA reviews your evidence + makes an access decision against the eligibility criteria. The decision is sent in writing. Statutory target: within 21 days of receiving complete evidence (NDIS Operational Guideline – Access). In practice the timeline can extend if additional evidence is requested.
First plan or review
Typical: 4–8 weeks after approval
If approved, you proceed to a planning meeting. The NDIA contacts you to schedule it – typically within 4–8 weeks. Your first plan is approved at this meeting + activates immediately. If your access request is declined, you can request an internal review (s100 NDIS Act) within 3 months + escalate to the Administrative Appeals Tribunal if needed.
Children under 7
Early Childhood approach (formerly ECEI)
Children under 7 enter the NDIS through Early Childhood Partners – local organisations funded by the NDIA to deliver this gateway service. The partner is your first point of contact, not the NDIA directly. The partner can:
- Provide initial supports without an NDIS plan (often enough for milder developmental concerns)
- Refer to community services that may meet the family\'s needs
- Help submit an Access Request if NDIS funding is needed
- Support the family through the first plan if approved
Find your local Early Childhood Partner at ndis.gov.au/contact/locations. Partners are organised by Local Government Area (LGA) – search your postcode. First-contact wait times vary by area: typically 2–6 weeks. Early Childhood Partners do not charge families – funding is direct from the NDIA.
Children aged 7+ apply through the standard NDIS process (Local Area Coordinator or direct NDIA contact).
If your application is declined
Internal review + AAT appeal pathway
Step 1 – Internal review (s100)
Within 3 months of the access decision, request an internal review under section 100 of the NDIS Act. The NDIA reviews the decision with fresh eyes. Submit new evidence if you have it – additional specialist reports, functional capacity assessments, treating professional letters. Free. Typical timeline: 60–90 days for a decision.
Step 2 – AAT appeal
If internal review confirms the original decision, apply to the Administrative Appeals Tribunal at aat.gov.au. External, independent. Free for NDIS matters. Can be self-represented or with free legal aid. Strong success rate – published AAT decisions are useful precedents for future applications.
Or – re-apply
A simpler path when circumstances or evidence have materially changed: re-apply for access with the new evidence. No penalty + no waiting period. Many applications declined first time succeed 6–12 months later with stronger evidence – particularly a fresh functional capacity assessment + a clearer treating professional letter.
Free independent advocacy is available through the National Disability Advocacy Program. Find a provider in your region at disabilityadvocacyfinder.dss.gov.au. Advocates do not provide legal advice but help prepare evidence, draft review requests + attend meetings as a support person.
Common questions
NDIS eligibility – common questions
What if my child is under 7?
Children under 7 enter the NDIS through the Early Childhood approach (formerly ECEI – Early Childhood Early Intervention). You contact an Early Childhood Partner (a local provider funded by the NDIA to deliver this gateway service) rather than the NDIA directly. The Early Childhood Partner provides initial supports + assesses whether a full NDIS plan is needed. Find your local partner at ndis.gov.au/contact/locations.
What if I am over 65?
If you first need disability support after 65, you access the aged-care system instead – Home Care Packages, residential aged care, the Commonwealth Home Support Programme. If you joined the NDIS before 65, you can stay on the NDIS for life. There is no requirement to transfer to aged care at 65 if you are already a participant. People who turn 65 can choose to remain on the NDIS OR transfer to aged care if they prefer that funding model.
How long does an access decision actually take?
The NDIA target is 21 days from receiving complete evidence. In practice, the time from first contact to access decision can be 8–16 weeks for straightforward cases + considerably longer for complex or borderline cases. Bottlenecks: time to see a specialist for evidence (often weeks-to-months), back-and-forth requests for additional information, NDIA caseload. Early Childhood Partners + Local Area Coordinators can sometimes accelerate timelines.
What if I am declined?
Three pathways: (1) Request an internal review within 3 months under s100 of the NDIS Act. Submit any additional evidence – functional capacity assessment, second specialist opinion, behaviour assessment. (2) If internal review fails, apply to the Administrative Appeals Tribunal (AAT). External, independent, free for NDIS matters. (3) Re-apply with new evidence at any time. Many people accept declined first-time access then re-apply 6–12 months later with stronger evidence + are approved.
Can I get free help with my application?
Yes. (a) Local Area Coordinators (LACs) are NDIA-funded organisations in every region – free help with the application process. (b) National Disability Advocacy Program (NDAP) – independent advocacy at disabilityadvocacyfinder.dss.gov.au. (c) Some condition-specific groups (autism associations, multiple sclerosis societies, etc.) help members through applications. (d) Some allied health professionals write strong NDIS-specific reports – your GP can refer you.
My condition is autism. Am I eligible?
Depends on the diagnostic level + functional impact. Autism Level 2 + Level 3 are on List B (likely to meet disability requirements). Autism Level 1 typically does NOT meet eligibility on its own – the functional impact threshold is not met. However, Level 1 autism with significant comorbid conditions (ADHD with functional impact, anxiety, intellectual disability) may meet eligibility through combined functional impact. Children under 7 typically enter via the Early Childhood pathway regardless of level – eligibility for ongoing NDIS funding is reassessed as they grow.
Does the NDIS cover mental health conditions?
Yes – psychosocial disability is explicitly covered under the disability requirements. The condition must be permanent or likely to be permanent + result in substantially reduced functional capacity. Schizophrenia, severe bipolar, complex PTSD + similar long-term mental health conditions can meet eligibility. Episodic conditions with intermittent capacity impact are harder to qualify – strong functional capacity evidence is essential.
What evidence is strongest?
Three categories carry the most weight: (1) Diagnosis from an appropriately-qualified specialist (psychiatrist for psychosocial, neurologist for neurological, paediatrician for childhood developmental), (2) Functional capacity assessment using a validated tool (WHODAS 2.0, Vineland Adaptive Behaviour Scales, Pediatric Evaluation of Disability Inventory), (3) Treating health professional letter describing day-to-day functional impact + ongoing support needs. NDIS-specific reports (written with the access criteria in mind) materially outperform generic clinical letters.
Are NZ citizens eligible?
Only Protected Special Category Visa (Protected SCV) holders – generally NZ citizens who arrived before 26 February 2001. NZ citizens on a non-protected SCV (the standard NZ-citizen visa for arrivals after that date) are not eligible for the NDIS. They may access state-funded disability services in some jurisdictions, but not the federal NDIS. NZ citizens can become eligible by taking out Australian permanent residency or citizenship.