Who Gets the NDIS?

There’s been a lot of talk lately about who can access the NDIS, and who can’t. The answers can be confusing, and the rules are changing, but we think it’s worth breaking it down as clearly as possible.

We’ve split it into two parts. This is Part One, which explains the current rules. Part Two looks at the proposed changes and what they might mean for people with disability, families, and providers.

Let’s start with the basics.

What is the NDIS?

The National Disability Insurance Scheme (NDIS) is the way the Australian government provides individualised support to people with permanent and significant disability.

You don’t get the NDIS just because you want help, or because you have a diagnosis. You get it if you meet the eligibility criteria in the NDIS Act, and the National Disability Insurance Agency (NDIA) thinks you need it.

Who qualifies?

You must meet all of these:

• You must live in Australia (with a specific type of residency)
• You must be under 65 at the time you apply
• You must have a permanent and significant disability or a developmental delay (under age 6)
• That disability must substantially reduce your ability to do everyday things on your own

You’ll usually need to provide evidence from medical or allied health professionals showing the type of disability, what caused it, what treatments have already been tried, and what it stops you doing.

Having a medical label or a test result isn’t enough. The NDIA wants to know what your daily life is like and where you need support.

What about kids under 10?

The rules are expected to change in coming years. The NDIS Review recommended that many children under 9 or 10, especially those with developmental delays or mild disabilities, should receive help through a new system of community-based “Foundational Supports” instead of individual NDIS plans.

These changes aren’t here yet, but they’re coming. For now, access is still based on current legislation, but it’s wise to get good advice if you’re applying on behalf of a child.

What does “permanent and significant” mean?

Permanent means the condition is likely to be with you for life. Significant means it impacts your ability to function day to day, not just once in a while.

The NDIA may use the phrase “substantially reduced functional capacity.” That means the disability affects your ability to do things like:

• communicate
• move around
• socialise
• learn
• manage personal care
• make decisions

What if I’m already getting help elsewhere?

If you get other support (from school, hospitals, aged care, etc.), the NDIA will take that into account. The NDIS is not meant to duplicate services that are already provided elsewhere. But if those services aren’t meeting your needs, or if you fall through the cracks, the NDIS may still help.

What if I used to be on the NDIS and was exited?

You can reapply, but you’ll need to prove you still meet the access criteria. Sometimes people are exited from the scheme because their situation improved or because the NDIA didn’t think the original evidence was strong enough.

The NDIS is trying to address cases where people are enrolled due to short-term need and stay in by default. That’s part of the wider review and reform process. See Part Two for more on that.

Where can I get help applying?

At Heartfelt Support, we don’t charge anything to chat with you about eligibility, although it’s not really our speciality. If we can’t help, we’ll try to connect you with someone who can. We also know some brilliant advocates.

We believe in the NDIS, but we also know it can be hard to get into, and hard to stay in. That’s why we keep up with every rule change, every new piece of jargon, and every client story that sheds light on how it all works in the real world.

Part Two explores what’s changing in the NDIS, especially around assessments, evidence, reviews, and that claim that “they don’t even read your reports anymore.” Spoiler: they legally have to. But the reality is more complicated than that.

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