Wondering whether you or a loved one is eligible for the National Disability Insurance Scheme (NDIS)? Then, you’re not alone. Every year, thousands of Australians apply for this scheme, hoping to access disability support, yet a lot of them are never sure whether they will qualify or not, which is why we’re here to brief.
The NDIS supports more than 500,000 Aussies annually who have permanent or significant disabilities, so that they may live independently. However, having a diagnosis alone doesn’t automatically make you eligible.
Every application is assessed by the National Disability Insurance Agency (NDIA) to see whether residents fit the criteria. This includes their age, residency status, and how their disability has affected them in daily life.
So, if you are trying to apply for funding but aren’t really aware of how, this blog explains everything. If you’re new to this, you can also read our guide What is NDIS? to get clarity.
Key Takeaways
- To meet NDIS eligibility, you must have a medical diagnosis, but that is not the only requirement.
- There are age, residency, and disability requirements that need to be met for access to the NDIS.
- The NDIA considers the impact of your disability on your life, rather than the disability itself.
- Important medical and allied health reports will complement your application.
- If your application isn’t approved, you can ask for the decision to be reviewed.
Are You Eligible for the NDIS?
To become an NDIS participant, you must understand the 6-Point NDIS criteria:
Do You Reside in Australia?
The first one is your residency status. You can only be supported by the NDIS if you are an Australian citizen, permanent resident, or are on a Protected Special Category Visa.
If you’re in any doubt, it’s worth making sure you know what they require at the time of your application.
Are You Under 65 Years of Age?
To meet the age requirement, you must be younger than 65 years old when you apply for the NDIS. Children under the age of 9 may access support through the NDIS Early Childhood Approach, but they can still become NDIS participants if eligible.
If you’re already receiving NDIS support before turning 65, you can generally continue with your plan even after that. However, people who apply for disability support after reaching the age limit are typically supported through the My Aged Care system instead.
If this basic requirement is not met, chances of being eligible for further assessment are highly unlikely.
Do You Have Any Permanent Disability?
NDIS funding is approved only if you have a disability that resulted in a permanent impairment, which means you have either lost a body part or are incapable of functioning for life.
Now, the disability requirements aren’t just about having a diagnosis. The NDIA also looks at how your impairment impacts your life without assistance with everyday tasks. These could be any of the following:
- Physical: how well you can walk around, out of bed, and do other physical activities in your community.
- Intellectual: Learning and grasping information: Remembering instructions, processing information, reading, writing, or learning new skills.
- Cognitive: Being able to think, concentrate, make decisions, solve problems, and handle money.
- Neurological: Your daily activities like showering, dressing, cooking, etc.
- Psychosocial: How you communicate and understand conversations, or interact with people.
These functional disabilities will determine the level of support required and whether you meet the disability access requirements.
Which Disabilities Meet the NDIS Eligibility Criteria?
Some conditions are more likely to be considered for NDIS access since they frequently lead to a long-term functional disability.
The following could make up the list:
- Autism spectrum disorder
- Intellectual disability
- Cerebral palsy
- Acquired brain injury
- Multiple sclerosis
- Down syndrome
- Vision impairment
- Hearing impairment
- Neurological disorders
- Rare genetic conditions
The NDIA has reference lists (also referred to as Lists A, B, C, and D) that are used to identify the evidence needed for specific conditions. There is no automatic entitlement to the NDIS for those on these lists, but it may ease part of the eligibility process for some people
Can Mental Health Conditions Qualify for the NDIS?
Yes, but only in certain circumstances.
The NDIS will not pay for an individual’s mental health condition. Instead, it can assist someone who has suffered from a psychosocial disability due to a severe and chronic mental health condition, which has also impacted their capacity to carry out everyday activities.
An individual with a schizophrenia diagnosis, bipolar disorder, or severe depression may have experienced issues with self-care, socialisation, communication, and/or independent living. If they continue to face these challenges and require support to overcome them, they might approach the NDIS.
Every time an application is received, it is assessed individually using supporting evidence from health professionals. This helps the NDIA understand how the condition impacts everyday functioning.
NDIS Eligibility for Children and Adults
The NDIS takes a different approach to assessing eligibility for children and adults, recognising that support needs can vary at different stages of life. Understanding these differences can help families and individuals navigate the application process with greater confidence and goals.
Children and early intervention
Children aged 0-7 who have a developmental delay or a permanent disability might be eligible for support through the NDIS.
A child’s early development is so crucial that early intervention can make a huge difference to their functioning and the amount of support they’ll require later in life.
This is in addition to the information parents and carers share; information from paediatricians and allied health professionals is also important.
Adults applying for the NDIS
Once eligible, adults can apply for the NDIS at any time in life, and the majority of people are under 65 years old when first applying.
No matter when you were diagnosed with a disability or when it was first noticed, the assessment will look at the same things: if your disability is permanent, how it impacts your daily life, and if you need ongoing support to participate more independently.
How to Check If You're Eligible for the NDIS
By now, you should have a pretty good idea of the NDIS eligibility criteria. The next step is to check whether you meet the basic criteria before submitting your application.
There are some simple questions to ask yourself to see whether you are eligible.
- Am I younger than 65 years?
- Am I an Australian citizen and a resident?
- Am I going through a permanent disability?
- Is my impairment interfering with my life in some major way?
- Do I have a signed document from a health care professional to support the claim?
If you said yes to these questions, then you might be able to make an NDIS Access Request. Before making an application, you may want to discuss your options with your healthcare provider or an experienced NDIS provider in Adelaide.
What Evidence Do You Need for an NDIS Application?
Please make sure to include supporting documents when applying for a position. It helps the NDIA learn about your disability, how it affects your life, and your need for support in your life.
For that, you might be required to give:
- Medical reports from GP and/or treating medical specialists.
- Input from allied health professionals – for example, an occupational therapist, psychologist, physiotherapist, or speech pathologist
- Functional Assessments that describe how your disability impacts your daily living.
- Records of the hospital or appropriate clinical records
- Details of any support provided to you, or any other challenges you might have at home, at work, at school, or in the community.
Common reasons for applications to be delayed
- Medical reports don’t explain how the disability affects daily life.
- Supporting documents are outdated or incomplete.
- The application doesn’t clearly demonstrate the need for ongoing disability support.
- Additional information is requested before a decision can be made.
What Happens If Your Application Isn't Approved?
The rejection of your application could be disappointing, but it doesn’t necessarily mean the process stops there.
There are several reasons an application can be denied, such as not having enough evidence to support the application; the NDIS may require further information to understand how your disability impacts you, or you may be eligible based on the grounds of disability you have.
If you think the decision isn’t justified, you can ask for an internal review. In certain cases, having new evaluations or other reports from your healthcare providers may assist with your request.
Explaining why your application wasn’t successful last time could give you a better chance of applying and getting it approved again.
How EasAbility Can Support Your NDIS Journey
Understanding the eligibility criteria is only the first step. Once you’ve accessed the NDIS, choosing the right supports can make a meaningful difference to your independence and quality of life.
At EasAbility, we support participants across Adelaide with a range of personalised NDIS support services, including:
- Supported Independent Living (SIL)
- Support Coordination
- Community Participation
- Daily Living Supports
- Capacity Building Supports
Whether you’re new to the NDIS or looking to make the most of your plan, our team can help you understand your options and connect you with the support that best suits your needs.
Bottom Line
The NDIS is a huge initiative and sometimes challenging to manage!
If you’re unsure of how to get started, it’s worth taking a look at our team here at EasAbility.
We are a registered NDIS provider and know the NDIS. Our support coordinators will help you access, understand, and use your NDIS plan.
Contact our Support Coordination team if you think you may be eligible for an NDIS plan, or reach out to us at 1300 068 565 for consultation.
Frequently Asked Questions
- If I have a disability, am I automatically eligible for the NDIS?
But it doesn’t mean that if you have a disability, you are automatically eligible for the NDIS. The NDIA also takes into account your age, where you live, and how your disability impacts your everyday life.
- Is it possible to access the NDIS without a diagnosis?
Usually, you will need to submit evidence from a qualified healthcare worker for the application. This will assist the NDIA in gaining an understanding of your disability and how it affects your life.
- Does autism automatically qualify for the NDIS?
Not always. Individual eligibility is determined based on the impact of autism on a person’s functioning and support needs.
- Are mental health issues covered by the NDIS?
Certain individuals with a psychosocial disability might be eligible if their disability is permanent or is expected to be permanent and has a major impact on functioning in daily life.
- Are children eligible for the NDIS?
Yes. If a child has a developmental delay or a permanent disability, they may be eligible for NDIS support, including early intervention as applicable.
- What if my NDIS application is rejected?
You can request an internal review of the decision from the NDIA. There may be other evidence that will also help make your case stronger, depending on your situation.
EasAbility Care – General Information Disclaimer
The information provided on this page is for general informational purposes only and does not constitute professional, legal, medical, or NDIS advice. While reasonable efforts are made to ensure the accuracy of the content, EasAbility Care makes no representations or warranties regarding the completeness, reliability, or suitability of the information provided.
Please note:
- EasAbility Care provides a range of disability support services designed to assist NDIS participants in achieving their goals, increasing independence, well-being, and community participation.
- EasAbility Care offers various NDIS-related supports, and the availability of specific services may vary depending on individual circumstances, funding, and location.
- Eligibility for NDIS funding and related supports is determined solely by the National Disability Insurance Agency (NDIA) based on a participant’s individual needs, goals, and assessments.
- Access to services, funding approvals, and support arrangements may vary depending on a participant’s NDIS plan and personal circumstances.
- Users should seek independent advice from the NDIA, Support Coordinators, Support Workers, Psychiatrists, Psychologists, General Practitioners, or other qualified professionals before making decisions based on the information available on this website.
To the maximum extent permitted by law, EasAbility Care accepts no liability for any loss or damage arising from reliance on the information contained on this website. This disclaimer may be updated at any time without notice.
