Many Australians are unsure how the National Disability Insurance Scheme (NDIS) determines who qualifies. Navigating the whole process seems pretty challenging for them. Before you come to a decision, remember that the assessment is primarily based on the functional impact of a physical, intellectual, psychological, cognitive, or psychosocial impairment for lifelong support, not a diagnosis alone. Read on this highly informative blog to learn more about NDIS eligibility, type of disability evidence required, and functional assessments to understand how NDIS assess disabilities.
What Is the NDIS Access Process?
NDIS Access Process is the authorised route to become a participant under National Disability Insurance Scheme (NDIS), outlined to decide whether a person qualifies for NDIS to acquire funded support. The purpose of access assessment is to ensure that the supports are only given to Individuals with significant and permanent disabilities. While access is the first administrative step of providing eligibility, planning happens after application is accepted under the scheme.
The Two Main Eligibility Requirements
1. Age Requirements
Must be under 65 at time of application
2. Residency Requirements
Must be either Australian citizen, permanent resident, or Protected Special Category Visa holder.
Location: Applicants must reside in Australia to meet these requirements.
Disability Requirements: What the NDIS Looks For
To meet disability requirements for NDIS, the NDIA have the following access criteria:
The disability (physical, cognitive, intellectual, neurological, psychosocial, visual or hearing) is permanent, meaning no further treatment can cure it.
It significantly impacts functional capacity in daily life activities, including mobility, learning, communication, or self management.
What Is a Functional Capacity Assessment?
The NDIS Functional Capacity Assessment (FCA) is an extensive evaluation conducted by allied health professionals, which measures how an impairment impacts on your everyday functioning – communication, mobility, learning, self-care, social interaction, self-management. It focuses on your functional capacity, not just medical diagnosis to decide support, and boost independence.
What Does “Permanent and Significant Disability” Mean?
Permanent and significant disability is the prime requirement for NDIS access criteria in Australia.
Permanent
- Likely to be lifelong
- Stable, but unpredictable
- No known cure
Significant Impact
- Requires ongoing support
- Limits ability to participate in community or employment
- Unable to function without assistance
How the NDIS Applies the “Reasonable and Necessary” Criteria
If someone qualifies, funded support must meet all the six NDIS reasonable and necessary criteria.
- Related to disability
- Good value for money
- Effective and beneficial
- Not more appropriately funded elsewhere
- What is reasonable for NDIS to fund
- Not included daily living costs
Early Intervention vs Permanent Disability Pathway
Early intervention eligibility
Children under 7 with delayed development or under 9 with permanent disabilities, requiring immediate support.
When permanency may not be required
For NDIS early intervention, the condition need not be lifelong. Here, the aim is providing support to minimize future disabilities.
Children and developmental delay
Support is applied to enhance independence and skills, when a child’s development (speaking, or walking) is slower compared to their mates.
Common Reasons NDIS Applications Are Declined
Here are some common NDIS application rejection reasons:
Insufficient evidence
Submission of a general practitioner’s letter or lacking specialists’s reports
Condition not considered permanent
Failed to prove the impairment is permanent, i.e. lifelong.
Functional impact not clearly documented
Not clearly describing functional limits on daily activities including communication, mobility or self-care.
More appropriate supports exist elsewhere
NDIS eligibility assessment considers that more appropriate supports exist through mainstream health systems rather than NDIS.
How to Strengthen Your NDIS Access Request?
Here are some of the practical advice of improving NDIS access request:
Obtain detailed allied health reports
Collect recent detailed functional capacity assessment from occupational therapists, specialists, or psychologists
Include examples of daily challenges
Be specific and honest while mentioning your worst-day challenges that clearly showcase that you are completely reliant on your family assistance.
Link condition to functional limitations
Clearly state your medical condition that limits your capabilities of performing daily living tasks.
Ensure documentation clearly addresses criteria
Include evidence required for NDIS support to showcase that even after trying conventional treatments, your impairment still remains, and you require a lifetime of support.
Frequently Asked Questions About NDIS Disability Assessments
Does a diagnosis automatically qualify me for NDIS?
No, a diagnosis doesn’t automatically qualify you for NDIS. Instead, you have to show how permanent your disability is that substantially reduces your working abilities.
What evidence is needed for an NDIS application?
For an NDIS application, different types of evidence including identity proof (birth certificate, medicare card), disability evidence (mental health plan), information on the frequency and type of support needed.
How long does the NDIS access decision take?
The NDIS usually takes an access decision within 21 days from receipt of completed application with supported documents.
Can I reapply if my application is declined?
Yes, you can reapply if your application gets declined. Instead of reapplying with the same information, strengthen your financial profile before final submission.
Who can complete a functional capacity assessment?
Occupational therapists and allied health professionals are specialized in conducting a functional capacity assessment.
