A guide to NDIS entitlements

The NDIS has brought big change for people with disability and those who care for and support them. If you are eligible for funding under the NDIS scheme, rather than accessing community or disability services that are directly funded by the government, you will be allocated funding, which you can then use to access disability supports and services.

These supports and services are provided in your community by NDIS providers. The Government still pays for you to get these services, but you have the choice about which providers you use and who gets paid the funding allocated to you.

Eligibility for NDIS

You will get funding under the NDIS if you:

1. have a permanent disability which causes you a permanent functional impairment;
2. are aged less than 65 years; and
3. are an Australian citizen or hold a permanent visa and living in Australia.

What is a permanent disability under the NDIS?

You have a permanent disability if you have a disability (or disabilities) which meets all of the following criteria:

1. An intellectual, cognitive, neurological, sensory or physical impairment or a psychiatric condition(s) which causes an impairment; and
2. Which is likely to be permanent; and
3. Which substantially reduces your functional capacity to communicate, socialise, learn, get around, look after yourself, organise your life etc; and
4. The impairment(s) affect your capacity for social and economic participation; and
5. You are likely to require for your whole life.

Note: All of the above (A-E) must apply, and impairments that fluctuate can still be permanent under this test.

For the purposes of point C, you have a “substantially reduced capacity” to do one of the above activities if:

1. you cannot effectively do the activity without help from technology, equipment (other than glasses) or home modifications; or
2. you usually need help (including supervision, guidance or prompting) to do the activity; or
3. you cannot do the activity even with the help of technology, equipment (other than glasses), home modifications or another individual.

Reviews of NDIS eligibility decisions

If your claim for NDIS funding is rejected, you can review that decision.

Your request for a review must be made within 3 months of the decision being made and, ideally, would provide extra medical information about your condition/disability to support the review.

If you remain unhappy after the review, you have appeal options at the Administrative Appeals Tribunal (AAT). Time limits apply for appealing a review decision.

Disability plans for eligible NDIS participants

Once it is decided that you are eligible for NDIS funding, you will be assessed by the NDIA (the body that administrates the NDIS scheme) to create a disability plan.  

As part of developing your disability plan, you must set out a statement of goals and aspirations. The disability plan is then put together by the NDIA using the statement of goals and aspirations, with input from relevant medical and disability professionals.

A disability plan must consider:

1. your regular activities and how often you do them; and
2. what supports you need to do your activities; and
3. the cost of those disability support services.

The above must be drafted into a disability plan. The disability plan will be costed by the NDIA, and once approved, funding will be allocated to cover what is needed to make the plan work. The amount of overall funding must take into account ALL of your activities and needs and your limitations to completing those activities.

For example, if your disability impacts your ability to drive at night, you might be allocated funding for 3 taxi trips a month to attend scheduled/regular evening appointments.

It is important that before meeting with the NDIA to discuss a disability plan, you have a good understanding of the funding available and what services that funding can be spent on. You should also list all of your activities and appointments and any associated disability supports required to perform/attend those activities or appointments.

Once a plan is approved, supports or services provided for by your disability plan can then be accessed by you and paid for using the NDIS funding. Each dollar allocated for each support must be spent on that particular support. In other words, you will have several “buckets” of funding/money that you can use to pay for the things that you need to support you in your everyday activities, but you can only take from the allocated bucket, and you cannot mix the funds.

If you are unsure if a support or service can be covered under a plan, you should include it anyway and ask the question.

Reviews and reviewable decisions

You can request an internal review if you are not satisfied with a decision:

1. to reject your application for NDIS funding; or
2. about the level or breadth of your disability plan/funding.

The internal review should set out why you are not satisfied and give extra information to support your request (e.g., from your doctor or from a carer or similar, to clarify the need for support/eligibility). If you are still unhappy with the plan after the review, you have appeal options at the Administrative Appeals Tribunal (AAT). Time limits apply for appealing a decision. 

Contacting Berrill & Watson

📞 Melbourne: 03 9448 8048

📞 Brisbane: 07 3013 4300

📞 Anywhere else in Australia:  03 9448 8048

📧 [email protected]

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