Access and Eligibility | Autism Awareness Australia

Introducing the National Disability Insurance Scheme

The National Disability Insurance Scheme provides individualised support for people with permanent and significant disability, as well as their families and carers.

The primary purpose of the NDIS is to support individuals with a significant and permanent disability (participants) to be more independent and engage socially and economically, while delivering a financially sustainable NDIS that builds genuinely connected and engaged communities and stakeholders’. (NDIS Corporate Plan 2022-2026)

The NDIS website has a wealth of information and we highly recommend you become familiar with the content in depth. In particular, the information around eligibility, access and planning are important.

Find NDIS Offices and contacts in your area.

NDIS helpline

Phone 1800 800 110

8am – 8pm Monday to Friday

There are also helplines for people with hearing and speech loss or who need help with English. Live web chat is also available on the NDIS website.

The National Disability Insurance Agency

The National Disability Insurance Agency (NDIA) is the independent statutory agency, whose role it is to implement the National Disability Insurance Scheme Act 2013 (NDIS).

Accessing the NDIS

To become an NDIS participant you must:

Have a permanent impairment that significantly affects your ability to take part in everyday activities, or have a developmental delay
Be aged less than 65
Be an Australian citizen or hold a permanent visa or a Protected Special Category visa

The process to access funding

infographic describing NDIS application process

Pathways to access the NDIS

There are two pathways to access the NDIS depending on the age of the participant.

Children 0–9 years

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If your child is aged 0-9 years (as of July 2023), they will access the NDIS via the early childhood approach. The early childhood approach aims to:

provide timely support to ensure that you are able to access the supports you need. The early childhood approach helps children younger than 6 with developmental delay or children younger than 9 with disability and their families to access the right support when they need it. Children younger than 6 do not need a diagnosis to get support through the early childhood approach where there are concerns about their development.
give you information about best-practice early childhood intervention supports and how you can help your child
increase your confidence and capacity to manage and respond to your child’s support needs
increase your child’s ability to do activities they need or want to do throughout their day
increase your child’s inclusion and participation in mainstream and community settings like childcare or recreation
give you information about, and referrals to, other support services if needed, like parent support groups. Read more about early connections support.

As an insurance scheme, the NDIS uses effective early intervention to reduce its medium to long term liability.
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Children aged 9 and over

If your child is aged 9 and over, access to the NDIS is via the NDIS Pathway. Follow the NDIS pathway to understand:

What is the NDIS?
Can I access the NDIS?
My first plan
Reviewing my plan

NDIS eligibility for autism spectrum disorder

The latest version of the Diagnostic and Statistical Manual (DSM-5) categorises Autism Spectrum Disorder into 3 levels:

Level 1 – requires support
Level 2 – requires substantial support
Level 3 – requires very substantial support

NDIS eligibility is based on reduced functional capacity in one or more of the following areas; communication, mobility, social interaction, learning, self-care and self-management.

A child diagnosed with autism is likely to have functional capacity impairments in several areas and to meet the access criteria. However sometimes a child diagnosed at Level 1 does not have functional deficits and does not meet criteria.

NDIS operational guidelines

Click here for more information on
‘Functional Capacity’ on the NDIS
website

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Local Area Coordination- meeting your LAC

The NDIA does not manage all participants centrally. It has partnered with many agencies to deliver the NDIS locally. You will be referred to your local area coordination partner and will be assigned a local area coordinator, your LAC. This is the person who is your main point of contact.

Your LAC will work with you to develop goals and aspirations. The LAC will help you asses your families needs and the types of informal and formal support that your child will need. The LAC then submits this to a Planner at the NDIA who finalises your child’s plan and sends it back to the LAC who will discuss it with you.

You should be able to talk on the phone to your LAC before you meet at your first formal planning meeting.

Preparing for your NDIS planning meeting

Attending an NDIS planning meeting can be daunting. Preparation is the key. Completing a pre-planning workbook can help to prepare you for the planning conversation.

The Association for Children with a disability have a NDIS planning workbook specifically for use by parents.

Your child's goals

You will be asked to identify goals and aspirations as part of your NDIS planning conversation. Use the SMART acronym to ensure your goals are:

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It is also useful to conceptualise your individual goals in a way that aligns them with the broader objectives of the NDIS. The scheme aims to support people with disability to increase their independence, increase social and economic participation and develop their capacity to participate in the community.

Tips for your planning meeting

Don’t go alone
Make sure you are well prepared
Go to NDIS information sessions if you can
Call the help line with any questions before
Speak to other families
Join one of the Facebook NDIS participant groups
Make a folder containing details about every single thing that you spend money on around disability support
Make sure you are clear about your child’s goals

It’s important to know: If you don’t agree with the funding you or your child is allocated by the NDIS, you do not have to accept it. You can request a review of the decision.

However, reviews can be time consuming and emotionally draining. The better prepared you are during the planning process, the more likely you are to secure the reasonable and necessary supports that you need without the need for review.

Remember that your child’s plan looks at formal and informal supports. Your LAC should be able to help you access support in the community which is available to your family.

What kinds of supports can be funded under the NDIS?

Before the NDIS planner makes a decision on what supports might be funded in a participant’s NDIS plan, they will take into account a participant’s network of informal supports (family and friends), mainstream supports (health, mental health, education) and community supports.

The NDIS will fund reasonable and necessary supports to help participants to reach their identified goals.

‘Reasonable and necessary’ are three very important words in the NDIS. It’s not as simple as whether a support might be ‘needed’, it has to meet 'reasonable and necessary' criteria outlined in the NDIS Act 2013.

Reasonable and Necessary supports help participants to:

Pursue Goals and Aspirations

Increase independence

Increase social and economic participation

Develop capacity to take part in the community

In order to be Reasonable and Necessary supports must:

Be related to your disability

Not include day to day living costs

Represent value for money

Be likely to be effective and beneficial

Take into account informal supports given
by family, carers, networks and the community

The types of supports that the NDIS can fund fall into three broad support purposes: Core, Capacity and Capital. These could include:

Daily personal activities
Transport to enable participation in community, social, economic and daily life activities
Workplace help to find and keep a job
Therapeutic support including behaviour support
Help with household tasks
Aids and equipment including assessment, setup and training
Home modifications
Mobility equipment
Vehicle modifications

The NDIS will not fund a support if it:

Is not related to your disability
Duplicates support funded by a different mechanism through the NDIS
Relates to day-to-day living costs
Is likely to cause harm or pose a risk to others

Options for managing the funded supports in your plan

There are 4 ways to manage the funding in your plan:

Self management gives you maximum control over, and responsibility for, your NDIS funds. It allows you to use your preferred service providers, including both registered and non-registered providers of support. You can make decisions in line with your plan goals, including paying above the NDIS price guide limits or bargaining for a better deal from providers.
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Plan management gives you increased control over how your plan is used. The financial intermediary helps you to pay your NDIS support providers by processing claims and paying invoices on your behalf. Using a plan manager allows you to use registered and non-registered providers of supports, however you need to stick to the price limits determined by the NDIS price guide.
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NDIA Agency management gives access only to registered providers of NDIS supports. Registered providers claim for services provided directly from the NDIA provider portal. You can access the MyPlace participant portal to see what claims providers are making against your NDIS funds and monitor expenditure. Registered providers are only able to charge in accordance with the NDIS Price Guide.
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A combination of any of the methods of management might suit you. For example, NDIA agency management of Improved Daily Living will allow your Allied Health professionals (speech, OT, Psych) to claim directly for therapy services, while self-managing Core supports could give you the choice and control to directly engage a team of support workers to help around the home and in the community and stretch your budget further.

Helpful resources

Understanding your
Plan and Supports

NDIS website

NDIS Self management

NDIS website

Writing a carer statement

ACD website

What to do if you are unhappy with an NDIA decision

If you think a decision made by the National Disability Insurance Agency (NDIA) is wrong, you can submit an application for a review of a reviewable decision.

Many decisions made by the NDIA are reviewable, including things like being accepted as a participant, the provision of reasonable and necessary supports, and becoming a registered provider of supports.
A request for internal review of a decision must be made within three months of receiving notice of the decision from the NDIA. The staff member who works on the internal review will not have been involved in the earlier decision.

You can use the Disability Advocacy Finder to search for NDIS Appeals providers and disability advocacy agencies across Australia.

Click here for more details on how to request a review of a reviewable decision

What if you are still unhappy after an internal review by NDIA

If you are still not happy after an internal review of the decision, you can apply for a review by the Administrative Appeals Tribunal (AAT). You cannot ask the AAT to review a decision by the NDIA until the decision has been internally reviewed by the NDIA.

For information about applying for a review by the AAT, see AAT: National Disability Insurance Scheme applicants or call 1800 228 333

Click here for information about applying for a review by the AAT, see AAT: National Disability Insurance Scheme

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