Are You Eligible For NDIS Funding?

Treating health professional

Any member of a multidisciplinary team:

• ABI health professionals.

Disability evidence (in preference order)

1. Care and need scale (CANS) (17 years and over)
2. World Health Organisation disability assessment schedule (WHODAS) 2.0 (17 years and over) or PEDI-CAT (16 years and under).

Health professional

Autism diagnosed by a specialist multi-disciplinary team, paediatrician, psychiatrist or clinical psychologist:

• Paediatrician
• Psychologist
• Psychiatrist
• Occupational Therapist
• Speech Therapist.

Disability evidence (in preference order)

1. Diagnostic and statistical manual of mental disorders, fifth edition (DSM-V)
2. Vineland adaptive behaviour scale (Vineland-II)
3. World Health Organisation disability assessment schedule (WHODAS) 2.0 (17 years and over) or
4. PEDI-CAT (16 years and under).

Treating health professional

• Occupational Therapist
• Physical Therapist
• Pediatrician
• Physiotherapist.

Disability evidence (in preference order)

1. Gross motor functional classification scale (GMFCS)
2. Other: Manual ability classification scale (MACS)
3. Other: Communication function classification system (CFCS).

Treating health professional

• Audiologist.

Disability evidence (in preference order)

1. Hearing impairment responses and groupings guide (17 years and over) or,
2. PEDI-CAT (16 years and under)
3. Other: Hearing acuity score

Health professional

Any member of a multidisciplinary team, such as a:

• Paediatrician
• Psychologist
• Occupational Therapist
• Speech Therapist.

Disability evidence (in preference order)

1. Diagnostic and statistical manual of mental disorders, fifth edition (DSM-V)
2. Vineland adaptive behaviour scale (Vineland-II)
3. World Health Organisation disability assessment schedule (WHODAS) 2.0 (17 years and over) or PEDI-CAT (16 years and under).

Treating health professional

• Neurologist
• Disease steps trained Nurse examiner.

Disability evidence (in preference order)

1. Disease steps
2. Patient determined disease steps (PDDS)
3. Other: Expanded disability status scale (EDSS).

Health professional

• Paediatrician
• Psychiatrist
• General Practitioner (GP)
• Psychologist (in limited circumstances).

Other specialist health professionals who can provide evidence:

• Clinical Psychiatric staff (eg. Mental health/Psychiatric nurses, Occupational Therapists, Social Workers)
• Mental Health Allied Health Professionals
• Australian Mental Health Outcomes and Classification Network (AMHOCN) trained mental health staff (including Mental Health Peer Workers).

Disability evidence

A statement from a treating health professional, including information about:

• how long they have been working with you
• evidence of the mental health condition, a diagnosis is helpful if available
• treatments you have explored and any you have not tried (with reasoning)
• how your mental health condition impacts on your everyday life (a functional assessment may be helpful).

Functional assessments (in order of preference): 

These can be provided by a treating health professional or other people as listed above:

1. Life Skills Profile 16 measure (LSP-16)
2. Health of the Nation Outcomes Scale (HoNOS)
3. World Health Organisation Disability Assessment Scale (WHODAS).

Find out more about providing supporting evidence on the Psychosocial disability page.

Treating health professional

Any member of a multidisciplinary team:

• Neurologist
• Physiotherapist
• Occupational Therapist
• Recreational Therapist
• Psychologist
• Psychiatrist.

Disability evidence (in preference order)

1. Level of lesion, or
2. American Spinal Injury Association Impairment Scale (ASIA/AIS)
3. World Health Organisation disability assessment schedule (WHODAS) 2.0 (17 years and over) or
4. PEDI-CAT (16 years and under).

Treating health professional

Any member of a multidisciplinary team

• Neurologist.

Disability evidence (in preference order)

1. Modified Rankin Scale (mRS).

Treating health professional

• Ophthalmologist.

Disability evidence (in preference order)

1. Vision impairment questionnaire (17 years and over) or
2. PEDI-CAT (16 years and under)
3. Other: Visual acuity rating.

Health professional

Any member of a multidisciplinary team, such as a:

• Paediatrician
• Psychologist
• Occupational Therapist
• Speech Therapist.

Disability evidence (in preference order)

1. Diagnostic and statistical manual of mental disorders, fifth edition (DSM-V)
2. Vineland adaptive behaviour scale (Vineland-II)
3. World Health Organisation disability assessment schedule (WHODAS) 2.0 (17 years and over) or PEDI-CAT (16 years and under).

Health professional

• Paediatrician
• Occupational Therapist
• Speech Therapist
• Physiotherapist
• Social Worker.

Disability evidence (in preference order)

1. World Health Organization disability assessment schedule
2. (WHODAS) 2.0 (17 years and over)
3. PEDI-CAT (16 years and under).

For some disabilities, information about impact on functionality may not be required

According to the NDIS, you must meet three fundamental criteria before your disability or early intervention needs are even considered:

• Age: You must be under 65 years of age on the day you apply.
• Residency: You must live in Australia.
• Citizenship: You must be an Australian citizen, hold a permanent visa, or hold a Protected Special Category Visa (for some New Zealand citizens).

Only if you meet all three of these requirements will the NDIS then assess you against the disability or early intervention requirements.

A permanent impairment is one that is "likely to be permanent," meaning it is enduring. The NDIS focuses on the impairment's lasting impact, not just the diagnosis. An impairment is considered permanent when there are no known, available, and appropriate evidence-based treatmentsthat are likely to remedy it (cure it or come close to removing its effects). Even if your condition is episodic (has good and bad periods) or degenerative (gets worse over time), it can still be considered permanent if treatments won't reverse it.

This is a key test. It means your permanent impairment significantly impacts your ability to undertake one or more of these six core daily life activities:

• Communication: Speaking, understanding, being understood.
• Social Interaction: Making friends, interacting with the community, behaving appropriately.
• Learning: Understanding and remembering new things, practising skills.
• Mobility: Moving around your home and community.
• Self-Care: Showering, dressing, eating, toileting.
• Self-Management (for those over 6): Making decisions, planning, solving problems, managing money.

You substantially reduce your functional capacity if you usually need significant help from other people (assistance, supervision) or assistive technology/equipment to do these activities.

Yes, under the early intervention requirements. The NDIS has a specific pathway for children under 6 with a developmental delay, which is defined as being much harder for the child to do everyday things compared to children of the same age. To be eligible, the NDIS must have evidence that the delay:

• Is due to a mental or physical impairment.
• Substantially reduces the child's functional capacity in one or more areas (self-care, communication, learning, etc.).
• Requires specialist services from more than one professional working as a team for longer than 12 months.

Yes, but eligibility is based on having a psychosocial disability, not just a mental health diagnosis. A psychosocial disability is the reduced capacity to do daily life activities and tasks because of your mental health. You must meet the same criteria as for a physical disability: your impairment (from your mental health) must be permanent and substantially reduce your functional capacity in one or more of the six key areas. Evidence from a psychiatrist or clinical psychologist is crucial.

• Disability Requirements: Are for people with a permanent impairment who are likely to need lifelong NDIS support. The focus is on ongoing support to build and maintain capacity.
• Early Intervention Requirements: Are for people (of any age) where early support is likely to benefit them by reducing their future needs, improving their functional capacity, or helping their family support them. The support may only be needed for a short time.

A person can be eligible under one or both sets of requirements.

You need two main types of evidence from qualified professionals:

1. Evidence of Permanent Impairment: This should come from a doctor or specialist (e.g., GP, paediatrician, neurologist, psychiatrist). It must confirm your diagnosis and explain why the impairment is likely to be permanent.
2. Evidence of Functional Impact: This can come from a doctor, specialist, or allied health professional (e.g., Occupational Therapist, Speech Pathologist, Psychologist). It should describe how your impairment affects your daily life across the six key areas of functional capacity.

The NDIS strongly prefers evidence from treating professionals who have known you for at least 6 months and are registered in Australia.

These lists help streamline the decision-making process:

• List A: Conditions that are likely to meet the disability requirements without further assessment of functional impact (e.g., severe intellectual disability, total blindness, spinal cord injury resulting in paraplegia).
• List B: Conditions that are likely to result in a permanent impairment but still require an assessment of how the impairment substantially reduces functional capacity (e.g., Autism Spectrum Disorder Level 1, Multiple Sclerosis, Cerebral Palsy not meeting severe criteria).
• List D: Conditions for children under 7 where the NDIS will likely decide they meet the early intervention requirements without further assessment.

Having a condition on a list is helpful, but you must still meet the age and residency requirements.

By law, the NDIS has 21 days to decide on your application after they receive a complete application. However, this clock stops if they need to ask you for more information. Once you provide the extra information, they have a further 14 days to decide. In urgent circumstances (e.g., hospital discharge, risk of homelessness), they can make priority decisions within 2-5 business days.

If the NDIS decides you are not eligible, they will contact you to explain why. You have the right to request aninternal reviewof the decision. This must be done within 3 months of receiving the decision. An NDIS staff member who was not involved in the original decision will review your application. If you disagree with the internal review outcome, you can apply for an external review by the Administrative Appeals Tribunal (AAT). You can also re-apply to the NDIS at any time if your circumstances change, provided you still meet the age requirement.

Yes. The NDIS Act specifically recognises that impairments can be "episodic or fluctuate in intensity." Your impairment can still be considered permanent if the overall impact on your life across your lifetime is significant. The decision will be based on your needs over time, taking into account the "ups and downs." The fact that you have periods of better functioning does not automatically disqualify you if the underlying impairment is enduring and substantially impactful during episodes.

The NDIS will assess whether the treatment is likely to "remedy" your impairment. They consider if the treatment is:

• Known: Identified as suitable by an Australian medical practitioner.
• Available to you: Genuinely accessible, considering any barriers you face.
• Appropriate: Suitable and safe for you to undergo.
• Evidence-based: Proven to be effective.
  Even if you are undergoing treatment, your impairment may still be considered permanent if the treatment is not expected to cure the impairment or significantly remove its effects (e.g., ongoing rehabilitation for a spinal cord injury).

This is a critical part of the criteria for children under 6. It means the child's needs are complex and cannot be met by a single therapist. The NDIS requires evidence that the child needs:

• Interdisciplinary care: Support from more than one type of professional (e.g., a Speech Pathologist and an Occupational Therapist) working collaboratively as a team.
• Support across settings: Help in multiple environments like the home, childcare, and the community.
• Individually planned and coordinated support: A team that communicates and creates a unified plan.
  This is to distinguish children who need the coordinated, complex support the NDIS provides from those who may benefit from short-term, single-discipline therapy.

If you become an NDIS participant on or after January 1, 2025, you will receive a Notice of Impairments. This document formally states the categories of impairments you met the eligibility requirements for. The categories are: Intellectual, Cognitive, Neurological, Sensory, Physical, or Psychosocial. This notice is important because your NDIS plan will fund supports specifically for these approved impairment categories. If you believe a category is missing or incorrect, you can apply to have the notice varied (changed) by providing new evidence.

Generally, no. If you are over 65 on the day you apply, you are not eligible for the NDIS. Support for people over 65 is provided through the aged care system (My Aged Care). The only exception is if you were already an NDIS participant before you turned 65. In that case, you can choose to remain in the NDIS or transition to aged care services.

This is a key part of the disability requirements. The NDIS will consider your overall situation, including:

• Your life circumstances.
• The nature of your long-term support needs.
• Whether your needs are best met by the NDIS or by other government services (like the health system).
  For example, if you have a chronic health condition that is primarily managed through medical treatment, the NDIS may decide you do not need NDIS-specific supports for your lifetime. However, if your disability requires ongoing, disability-specific supports to build and maintain capacity, the "lifetime" requirement is likely met.

The NDIS acknowledges this challenge. If you live in an area classified as MM6 or MM7 on the Modified Monash Model (Remote or Very Remote), you should inform the NDIS. They understand that accessing treating professionals is harder. In these cases, depending on what services are available, you may not need to provide as much evidence as someone in a major city. The key is to communicate with the NDIS about the difficulties you face in obtaining reports.

Yes, there are circumstances where you may leave the NDIS. This can happen if:

• You no longer meet the eligibility criteria: This is most common for participants who entered under the early intervention requirements. If, after receiving supports, you have built your capacity and no longer need NDIS funding, you may not meet the criteria anymore.
• You request to leave.
• A child with developmental delay turns 6: They will be reassessed against the permanent impairment criteria to remain a participant.
  The NDIS will check your eligibility during plan reassessments, especially if there is evidence your situation has changed significantly.

In certain urgent situations, the NDIS will fast-track an application and decide within 2 to 5 business days. Situations that qualify for priority decision-making include:

• A child under 7 with a newly diagnosed hearing impairment.
• A person with a terminal illness.
• Imminent risk of homelessness or breakdown of caring arrangements.
• A person being discharged from a hospital with a new significant disability (e.g., spinal cord injury) or a younger person leaving residential aged care.
• A person is being released from a custodial setting with appropriate supports not in place.
  You should inform the NDIS immediately if your situation matches one of these criteria.

You can get direct, expert help with your application right here at Beyond Health Services. You don't need to navigate this complex process alone.

Our comprehensive application support includes:

• Eligibility Guidance: We will help you determine if you meet the NDIS criteria and advise on the best pathway for your situation.
• Evidence Gathering: We work directly with you and your existing treating professionals (like your GP or specialist) to ensure all the necessary medical and functional evidence is collected.
• Functional Capacity Assessment: Our core service is conducting the detailed assessments that provide the NDIS with the robust evidence it requires to understand the impact of your disability. This is often the most critical part of a successful application.
• Form Completion Support: We will assist you in completing the Access Request Form (ARF) and any other required documentation, ensuring it is clear, compelling, and accurately reflects your needs.
• Liaison and Submission Support: We can help prepare your application package and guide you on how to submit it correctly to the NDIS.

We are your partner in this process. Our goal is to build the strongest possible application for you, giving you the best chance of a successful outcome and accessing the supports you need to achieve your goals.

Contact us today, and let's start your NDIS journey together.