Understanding NDIS Eligibility: How to Determine If You Qualify for NDIS Support Funding

The NDIS (National Disability Insurance Scheme) is intended to provide long-term support for people with permanent and significant disabilities.

Nonetheless, determining who is eligible for funding and how to begin can be challenging, so we have created a guide to NDIS eligibility to assist you with the initial steps.

Who can receive NDIS funding?

To qualify for the NDIS, you must meet three primary criteria: Residency status, age, and disability.

If you meet these criteria, you qualify to apply for NDIS funding.

Let's explore these eligibility criteria further:

1. What are the Residency Requirements for the NDIS?

To be eligible for the NDIS, you must be an Australian citizen or possess a Permanent or Protected Special Category Visa (SCV).

You must provide proof that Australia is your place of residence and that you spend the majority of your time here. Agreeing to let the NDIS access your Centrelink record usually supplies all the necessary information.

2. What are the Age Criteria for the NDIS?

If you are between the ages of 9 and 65, you qualify to apply for NDIS funding, provided you meet the other necessary criteria.

Those outside this age range have different support options:

• Children under the age of 9 can receive assistance through the NDIS early childhood approach. This program supports children under 6 with developmental delays and children under 9 with disabilities.

• Individuals over the age of 65 can access various programs for older adults, such as Continuity of Support, Commonwealth Home Support, and Home Care Packages.

  
  

3. What are NDIS Disability Requirements?

To qualify for NDIS funding, you must provide evidence showing that:

• Your disability results from an impairment.

• Your impairment is expected to be permanent.

• Your permanent impairment significantly limits your ability to perform everyday activities.

• Your permanent impairment affects your capacity to work, study, or engage in social life.

• You are likely to require lifelong support under the NDIS.

  
  

You aren't required to verify your disability each time your plan is reviewed. However, if your circumstances change or your needs aren't being addressed, you should contact your LAC (Local Area Coordinator).

Steps to Access the NDIS

After confirming your eligibility, you can fill out an Access Request form. This verifies your identity and suitability and provides your consent for the NDIS to gather information from third parties (such as Centrelink). You can complete this process in a few different ways, as below:

1. Verbally - by calling the NDIA at 1800 800 110. You can request the application form to be sent to you by post or email, fill it out, and return it to the NDIS. Your LAC can assist if you have trouble making the call or completing the form.

   
   

2. In person - by visiting your nearest NDIS office. If you prefer to drop by, and there's an NDIS office or LAC nearby, you can pick up the form there. You can search the nearest NDIS office from the link HERE

   
   

3. Online - by downloading the Access Request Form. After completing the form, you can return it via email (NAT@ndis.gov.au), mail it to GPO Box 700, Canberra ACT 2601, or submit it to your nearest NDIS office.

   
   

Sometimes, your physical location might be a limitation—such as not living near an NDIS office or lacking an LAC in your area. In such cases, we recommend calling the NDIS directly or downloading the form online.

Essential Elements of the Application

You must present documentation of your identity, age, residency, and proof of your impairments.

Proof of identity consists of copies of valid identification documents, examples of which are available in the Evidence of Identity Factsheet within the application form. If you are unable to provide any of these documents, you should contact the NDIS to explore alternative ways to verify your identity.

Depending on your age and residency status, you have the option to either allow the NDIS to access and utilize your Centrelink record or provide copies of documents and other evidence directly to the NDIS.

Providing evidence of impairments

Your healthcare provider, such as your GP, a specialist, or an allied health service provider, can offer evidence of a permanent and significant disability. 

The most suitable treating professional will have been working with you for at least six months, is qualified and registered in their field, and is the most suitable professional to provide evidence regarding your impairment. 

NDIS impairment notices

Starting January 01, 2025, every new access request will be issued an impairment notice detailing their impairment(s) and indicating if they meet the criteria for disability or early intervention (or both, in certain cases). Existing participants will receive notice during the transition to the new framework plans.

This modification seeks to enhance the clarity in identifying and communicating a participant’s impairment(s) as part of the access and planning process.

What if you do not qualify for NDIS funding?

If your Access Request is unsuccessful, there are other avenues for services and support you might consider.

Another option is to reapply. If you possess new evidence demonstrating how your disability affects your daily life, or if your circumstances have changed, you can submit a new access request. You also have the right to ask the NDIA for an internal review of your access decision.

Note: If your access request is under review, or if your participant status has been revoked and you request a review of that decision, you must wait for this process to conclude before submitting a new request.

What are the next steps after approval?

If your Access Request is approved, that would be excellent! This is when you can begin collaborating with your LAC or NDIS Planner to arrange planning discussions,

and establishing the framework of your plan to offer reasonable and necessary NDIS support.

At this stage, you should also consider how you prefer to handle the financial components of your plan. Three choices (self-managed, plan-managed, or agency-managed) offer different degrees of administrative responsibility and flexibility.

Plan management could be the most attractive option if you wish to retain control over selecting support providers while delegating the complex financial administration to someone more familiar with the NDIS system and its details.

See related: NDIS Self Managed vs Plan Managed vs Agency Managed Explained.

Changes to plan management in 2024

The NDIA can alter how your plan is managed, especially if you, your nominee, your current plan manager, or your child representative are evaluated as possibly mismanaging NDIS funds. This change currently affects self-managed participants but will eventually extend to those using a plan management provider.

ELS Plan Managers: Making your NDIS journey easier

Our experienced team are passionate about assisting people living with disability by effectively managing your plan funding so you can stay focused on achieving your goals (rather than invoices, budgeting and record-keeping).

You also benefit from clear communication, prompt provider payment, and phone app access to our user-friendly portal.

Ready to make managing your NDIS plan easier?

To learn more or to get started, contact ELS today.