Do You Meet NDIS Eligibility Criteria?

The National Disability Insurance Scheme (NDIS) provides supports and services to people with disabilities in Australia. It aims to help disabled persons to perform day-to-day tasks through the provided supports and help them realise and achieve their goals. Since its rollout, over 400,000 disabled Australians have reaped the benefits of the said scheme. However, the issue of eligibility and access for the marginalised arose as the number of participants increases every year.

One common problem brought upon was the eligibility criteria. Not every disabled person in Australia is allowed to access NDIS. The National Disability Insurance Agency (NDIA) provided a set of criteria that must be complied upon registration.

A prospect must meet the following requirements:

Age requirements;
Residence requirements; either
Disability requirements; or
Early intervention requirements

The age and residency requirements are the first requirements that the NDIA needs to assess before evaluating if the prospective participant meets either the disability requirements or early intervention requirements. The last two needs further assessment such as diagnosis, practical assessments, and other evidence that would support the person’s eligibility.

A person can access the NDIS if he or she meets the criteria:

Aged 7-65 years old;
Has a permanent, lifelong disability that affects the ability of the person to perform day-to-day tasks including conditions that vary in intensity such as mental illness;
Lives in Australia where the NDIS is available; and
An Australian citizenship or a permanent visa holder or Special Category Visa holder

Let’s discuss each requirement and find out if you or your child or a member of the family is eligible to access NDIS.

Age Requirements

People with disability who are aged 7-65 years old upon access request are eligible to access NDIS. People who are aged 66 years old and above upon access request are not eligible to access NDIS because the Commonwealth Aged system provides support for the aged people. Also, some NDIS areas including South Australia, Tasmania, and Queensland require additional age requirements specified in Schedule A. New South Wales, Victoria, Australian Capital Territory, Western Australia or Northern Territory do not need additional age requirements. The additional age requirements are only temporary and only apply during the NDIS progressive rollout.

Residence Requirements

The residence requirements need further assessment compared to the age requirements. The requirements also apply when a person seeks to become a participant and continue to apply during the prospect’s participation. The access to NDIS can be revoked when a person does not meet the residency requirements anymore.

A disabled person can access NDIS if he or she resides in Australia and an Australian citizen or a permanent visa holder or Special Category visa holder. For those who spend much time overseas, there are certain indicators that they could meet. The important matter is a person who spends much time overseas should have strong ties in Australia such as homeownership, the presence of assets in Australia, etc. The place of employment is also a good indicator that a person is a resident of Australia. However, this does not mean that people who stayed their whole life in Australia are the ones eligible. People who spent time overseas for work or vacation are still eligible.

Furthermore, people with a permanent visa or a special category visa can also be eligible.

The additional residence requirements specified in Schedule A for residents of South Australia, Queensland, New South Wales, and Victoria should be met. For children residing in South Australia, Queensland, New South Wales, and Victoria, the child must be:

Under the care of a person with ongoing responsibility for the child and resides in an NDIS area;
At least one of the birth parents who take care of the child resides in an NDIS area; or
If parents are separated and the child spends with each parent, at least one of the parents reside in an NDIS area.

People in Western Australia and the Northern Territory should also meet the specified additional requirements.

The factors to be considered in assessing the residence requirements are:
Person’s address on the electoral roll
The address to which the person’s mail is delivered
The continuity and length of time the person has lived in the area
Whether the person also lives or sleeps at other places
Where the person keeps their furniture and personal belongings; and
Whether the person’s family live there

Disability Requirements

A person can access NDIS if the prospect has a disability that is attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments or one or more impairments attributable to a psychiatric condition.

Furthermore, the person can access NDIS if the impairment substantially reduces the functional capacity of the person in one or more activities including communication, social interaction, learning, mobility, self-care, or self-management.

Moreover, if the disability affects the person’s capacity for social and economic participation and the disability is likely to require support for a lifetime, then the person is eligible to access NDIS.

When can a disability attributable to impairment?

The NDIS defines impairment as a “loss of, or damage to, a physical, sensory, or mental function”. On the other hand, NDIS defines disability as a “reduction or loss of an ability to perform an activity”.

In assessing the disability requirements of a participant, the NDIS does not consider the origin or cause of the disability as long as the disability reduces the ability of the person to perform an activity.

A disability is considered permanent when no known, available, and appropriate evidence-based treatments that would likely remedy the impairment. An impairment that varies in intensity can also be considered as permanent. Other considerations are: the impairment is degenerative in nature, if medical treatment would not improve the condition, may continue to be treated and reviewed after its permanency has been demonstrated, does not require further treatment or review to demonstrate its likely permanency, and the severity of its impact on the functioning impact of the person may fluctuate or potentially improve.

An impairment can be considered to substantially reduce the functional capacity is when:

the person is unable to perform the activity completely or effectively without assistive technology, equipment, or home modifications
the person usually requires from others to perform the activity
the person is unable to participate even without assistance from others or any equipment

In the case of a child, the impairment that results in a substantially reduced capacity must be relevant to other children of the same age.

If the impairment does not currently result in reduced functional capacity, the prospect can still access NDIS if he or she meets the early intervention requirements.

Early Intervention Requirements

According to the NDIS, the early intervention aims to “alleviate the impact of the impairment by providing support as early as possible and to reduce the need for support in the future.”

The NDIA determines if the NDIS is likely to benefit the person in terms of reducing future needs, improving functional capacity, and strengthening informal supports. The factors to determine if early intervention is necessary or beneficial are the trajectory and impact of the impairment over time, potential benefits, and evidence to support the claim.

Early intervention is commonly for children with developmental delays.

The early intervention requirements are reassessed to ensure that the person still needs the support.