Health

Who Qualifies for the National Disability Insurance Scheme (NDIS) in Australia?

Are you wondering if you or someone you love qualifies for the National Disability Insurance Scheme (NDIS)? Getting support through the NDIS can be life-changing for Australians with disabilities. But not everyone meets the eligibility criteria.

In this complete guide, we’ll break down exactly who can access the NDIS. You’ll learn about the requirements around age, residency status, disability type and more. We’ll also explain how to apply and what documents you need to provide.

Whether you’re an individual with disability or a carer, read on to find out if you qualify for NDIS funding and services.

What is the NDIS?

Before we dive into the eligibility criteria, let’s quickly cover what the NDIS actually is.

The National Disability Insurance Scheme is a support system for Australians with permanent and significant disabilities. It provides funding for services and equipment to help participants live an ordinary life.

The NDIS aims to:

  • Provide reasonable and necessary supports for participants
  • Give participants more choice and control over their supports
  • Take a lifetime approach to a participant’s care

Instead of providing block or grant funding to service providers, the NDIS gives funding directly to individuals. Participants can choose the services and providers that suit them best.

The NDIS was launched in 2013 and is now available across most of Australia. It supports over 500,000 participants nationwide.

NDIS Eligibility Criteria

Now let’s get into the NDIS eligibility criteria. To qualify for the NDIS, you must meet requirements in four key areas:

1. Age Requirement

To qualify for the NDIS, you must be aged between 7 and 65 years when you first apply.

Children under 7 may be able to access the Early Childhood Early Intervention approach. This provides support for early development and transition to school.

People over 65 can no longer enter the NDIS. However, existing participants can remain in the scheme over 65.

2. Residency Status

To qualify for the NDIS, you must live in Australia and be one of the following:

  • An Australian citizen
  • A permanent resident
  • A Protected Special Category Visa holder

If you are a temporary visa holder, you may be covered by the NDIS if your visa is valid for at least 12 months from the date you apply.

If you are an asylum seeker, you can apply to access the NDIS if you hold a valid Bridging Visa Class E (BVE).

3. Disability Requirements

To be eligible, you must have a permanent disability that significantly impacts your ability to take part in everyday activities.

Specifically, your disability must:

  • Be attributable to a cognitive, intellectual, neurological, sensory or physical impairment or a psychiatric condition
  • Be permanent (meaning it is likely to be lifelong)
  • Substantially reduce your functional capacity or psychosocial functioning
  • Affect your capacity for social and economic participation

The NDIS does not have a list of eligible disabilities. Any disability that meets the above criteria can qualify you for the scheme.

Some examples of eligible disabilities include:

  • Autism
  • Cerebral palsy
  • Down syndrome
  • Intellectual disability
  • Spinal cord injury
  • Stroke
  • Vision impairment
  • Hearing impairment
  • Mental health conditions
  • Acquired brain injury

Your disability must also be fully diagnosed, treated and stabilised to the extent possible.

4. Residency Location

The final criteria is that you must live in an area where the NDIS is available.

The NDIS has rolled out across most of Australia over several stages. It is now active in all states and territories except for some remote parts of Western Australia.

You can check if the NDIS is available in your area using the rollout map on the NDIS website.

How to Apply for the NDIS

If you meet all the eligibility criteria above, you can go ahead and apply for access to the NDIS.

Here are the steps to apply:

1. Check Your Eligibility

First, you can use the NDIS Access Checklist to get an indication of whether you might qualify. This online tool walks you through the key criteria.

2. Make a Verbal Application

You can call the NDIS directly on 1800 800 110 to make a verbal application over the phone. You will need to:

  • Confirm your identity
  • Provide consent to apply
  • Answer questions about your disability and support needs

This initial call registers your intent to apply.

3. Complete an Access Request Form

The next step is to complete an Access Request Form, which you can submit online or in hard copy. This form collects all the details needed to assess your eligibility, including:

  • Your personal details
  • Information on your disability and diagnosis
  • Your support needs
  • Any evidence or assessments you already have

Download the form from the NDIS website or call them to request a copy.

4. Provide Supporting Evidence

In addition to the Access Request Form, you will need to supply evidence to support your application.

This could include things like:

  • Medical, clinical or specialist reports confirming your disability
  • Assessments detailing your functional capacity
  • School reports or educational psychology reports
  • Diagnostic assessments
  • Information from health professionals involved in your treatment
  • Existing care or support plans

Providing as much evidence as possible will help speed up the application process.

5. Submit Your Application

Once you've filled out the form and compiled your supporting documents, you can submit your application to the NDIS in one of these ways:

If you need assistance with the application process, you can contact your local area coordinatorearly childhood partner, or NDIA office for help.

6. Wait for a Decision

Once you submit your NDIS access request, the NDIA will review it and decide if you meet the access requirements. They may contact you for additional information during this process.

You will receive written notification from the NDIA advising whether your access request has been accepted. If approved, you will be contacted to discuss your first NDIS plan.

The NDIS aims to make access decisions within 21 days. However, this can take up to 90 days if more evidence is required.

Documents Needed to Apply

When submitting an NDIS access request, you need to provide documents to verify your identity and demonstrate you meet the disability criteria.

Here are some of the key documents you may need to supply:

Proof of Identity

  • Birth certificate or passport
  • Medicare card
  • Concession cards
  • Driver's license
  • Utility bills

You need to provide at least one birth/arrival document, plus two community use documents.

Completed Access Request Form

Download this form from the NDIS website and fill it out with your personal details, disability information and support needs.

Medical and Specialist Reports

  • Diagnostic assessments confirming your disability
  • Reports from doctors, therapists or other treating health professionals
  • School reports or educational psychology assessments
  • Existing care plans or support plans

Other Relevant Evidence

  • NDIS Worker Screening Clearance (if you intend to become an NDIS worker)
  • Visa documentation (for temporary visa holders)
  • Evidence of your Nominee or Correspondent (if applicable)

Provide as much information as you can to help verify your eligibility. Contact the NDIA if you are unsure what documents to supply.

Special Cases

There are a few special circumstances that impact a person's eligibility for the NDIS.

Psychosocial Disability

People with a psychosocial disability related to a mental health condition may qualify for the NDIS.

Your mental health condition must be permanent and involve significant functional impairment. Evidence from a psychiatrist will usually be required.

NDIS Worker Screening

If you intend to work or volunteer with NDIS participants, you must complete an NDIS Worker Screening Check.

You will need to provide identity documents, a photo and potentially other evidence as part of this screening process.

Different Rules in WA

Western Australia has adopted a state-based NDIS model called NDIS WA. It has some different eligibility and entry requirements compared to the national NDIS.

Check directly with NDIS WA if you are in Western Australia.

Next Steps After You Qualify

If your access request is approved, an NDIS planner will work with you to determine your reasonable and necessary supports. They will develop your first NDIS plan detailing the funding you will receive.

Your plan will be reviewed annually to make sure you are getting the supports you need. Your eligibility may also be rechecked every 1-5 years depending on your circumstances.

Ready to take the next step? Now you know exactly who qualifies for the NDIS. We hope this guide has helped you understand the eligibility criteria and how to apply.

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