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Chapter 12 Section C: Accessing the NDIS

Overview

The National Disability Insurance Scheme (NDIS) has a role in supporting inclusive communities where everyone can create and pursue their personal aspirations and goals. The Scheme is available to make it easier for all Australians to receive information and connections to services in their communities that will assist them in their daily life and help them participate more fully in the community. This section will focus on how all Australians who are living with mental health conditions (described as psychosocial disability under the Scheme) can receive assistance from the NDIS and from other mainstream services.

This section will provide information about:

  • How to access the NDIS;
  • Who can support you in accessing the NDIS;
  • The eligibility requirements to access the NDIS;
  • How you will find out if you’re eligible for the NDIS;
  • What if you don’t meet the eligibility requirements for the NDIS?
  • Do you have to prove that you have a psychosocial disability?
  • The role of GPs in the NDIS.

12C.1: How to access the NDIS

If you think you are eligible for the NDIS, you can download an Access Request Form, and a Supporting Evidence Form.

The NDIS Access Request Form gathers information about you, your supports and about your disability.

You can work with your general practitioner, allied health and specialist medical professionals to provide the information required. You can also complete the form over the phone with an NDIA representative or you can ask to fill out a hard copy of the form and return it to an NDIA office. You will be asked to provide the following information:

  • your name, age, where you live and whether you have permission to live in Australia permanently;
  • evidence of your age and address;
  • information about your disability and how it impacts your day-to-day functioning and activities;
  • current and/or relevant reports you have from medical specialists or allied health professionals such as occupational therapists; and
  • whether you give permission for the NDIA to talk to other people about your disability, including Centrelink, your general practitioner or a person providing support to you.

To find out more about applying for access to the NDIS, click here.

You can call the NDIA on 1800 800 110* between 8:00am to 8:00pm, Monday to Friday.

Once your access request is made, the NDIS will send you a letter requesting any further evidence you need to provide. You can send your evidence to the NDIA via:

Mail: GPO Box 700, Canberra, ACT, 2601
Email: NAT@ndis.gov.au
In person: drop in to your local NDIA office

*Mobile phone calls to freecall numbers (numbers starting with 1800) are charged to the caller at the usual mobile rate.

12C.2: Who can help me access the NDIS?

There are several services that can support potential participants with the initial stages of engaging with the NDIS.

12C.2.1: Local Area Coordinators (LAC)

Local Area Coordination partners are organisations working with the NDIA to help individuals, their families and carers to navigate and access the NDIS. Local Area Coordinators (LACs) employed by these organisations assist participants to plan and coordinate services in a way that maximises their choice and control over the services they use. This includes supporting the person to navigate mainstream services, to increase their access to services and more actively participate in their community.

For those who meet Access Requirements, the LACs can assist with supporting you to:

  • understand and access the NDIS;
  • get ready for your plan;
  • develop your plan;
  • get your plan going; and
  • keep in touch with you, if you need help with your plan.

When deciding whether a prospective participant meets the Access criteria, the NDIA will first consider whether a person meets the age and residence requirements. If both the age and residence requirements are met, the NDIA will then consider whether the prospective participant meets either the disability or early intervention requirements.

For most people aged seven (7) and above, a LAC working for one of NDIS’s Partners in the Community will be your main contact point for the NDIS. To find out where your local LAC is located, click here.

In NSW, organisations delivering LAC services are:

  • Uniting – covering Nepean Blue Mountains, Northern Sydney, Western Sydney, Southern NSW, Illawarra Shoalhaven.
  • St Vincent de Paul Society NSW – covering South Western Sydney, Central Coast, Hunter New England, Sydney and South Eastern Sydney.
  • Social Futures – covering Far West, Murrumbidgee, Mid North Coast, Northern NSW and Western NSW.

Local Area Coordination partner offices are located in NSW, click here for locations.

For further information on how your Local Area Coordinator can assist you, visit the NDIS website.

12C.3: Eligibility requirements to access the NDIS

The NDIS has been designed to meet the day-to-day needs, goals and aspirations of participants. This is why you do not need to have a formal mental health or psychosocial disability diagnosis to be eligible for NDIS funded services.

The National Disability Insurance Scheme Act 2013 determines who can and cannot access the individualised plans created under the NDIS. To receive an NDIS package, you must:

  • be an Australian citizen, or a permanent resident, or hold a Protected Special Category visa*;
  • be under sixty-five (65) years old when they apply;
  • live in an area where the NDIS is available; and
  • meet the disability requirements which are outlined in the NDIS Act 2013.

You will meet the disability requirements and be eligible to access NDIS services if:

  • your impairments are likely to be permanent (impairments that change in intensity, for example serious episodic symptoms of some mental health conditions may still be classed as permanent);
  • your disability significantly affects your ability to perform everyday tasks or participate in activities; and
  • you are likely to require support under the NDIS for your lifetime.

You are likely to be eligible for the NDIS if you usually need support from a person or assistive equipment to:

  • be mobile (for example, getting out of bed, moving around at home, and getting around outside the home);
  • communicate to others or be understood by other people;
  • interact socially (for example, creating and maintaining relationships, and managing emotions and feelings);
  • learn (for example, understanding, remembering and learning new information);
  • take care of your physical wellbeing (for example, showering, dressing, eating, and taking medication); and/or
  • manage your life (for example, managing finances, maintaining your home, and making decisions).

There is no ‘means test’ for the NDIS, which means that a person can become a NDIS participant no matter what their personal income and assets are.

The National Disability Insurance Agency has an NDIS Access Checklist that is helpful in understanding what is needed to meet the access requirement.

12C.4: How will I know if I am eligible for the NDIS?

The NDIA will contact you to inform you of their decision within twenty-one (21) days of receiving your application and supporting evidence. The NDIA will send a letter informing you of their decision that you have or have not been approved to receive an NDIS package. This is called an ‘access decision’. If the NDIA has found you to be ineligible, they will provide information explaining their decision.

If you believe the NDIA has made an incorrect decision, click here for more information about how to request a review of an NDIA decision.

12C.4.1: Am I eligible for the NDIS if I have received financial compensation for my disability?

A potential participant may have received, or is currently receiving, a compensation payment from an insurance company, statutory scheme, or an individual/organisation due to an accident or injury which resulted in significant functional impairment.

If your acquired impairment is likely to be lifelong and significantly impact your daily functioning, you can still be eligible for an NDIS package. However, if your compensation payment is used to cover the cost of support needs, the value of the reasonable and necessary supports in your NDIS package may be reduced by the Compensation Reduction Amount as calculated by the NDIA. If you disagree with the Compensation Reduction Amount, you are entitled to request a review of the decision.

Follow this link for more information in this manual about review of NDIA rulings.

If you have received a lump sum compensation payment from a commercial insurer to pay damages for pain and suffering, loss of income, medical costs, or a Victim of Crime payment, your NDIS plan will not be affected.

When applying for the NDIS, you will need to fill out a Compensation Information Form, which provides the NDIA with information regarding the compensation payment, supporting documents for the compensation payment, and information concerning spending compensation payments on services and supports which the NDIS could potentially fund in a support package.

There is no ‘means test’ for the NDIS, which means that a person can become a NDIS participant no matter what their personal income and assets are.

For more information about compensation payments and the NDIS, follow this link.

12C.5: What if I don’t meet the eligibility requirements?

You do not have to be an NDIS participant to receive support for your disability. If you are not eligible to participate in the NDIS, NDIS Local Area Coordinators (LACs) are available to help provide short-term assistance to those who do not have an NDIS plan.

LACs offer all people information about what supports are available to you and offer suggestions of relevant supports and services which will best meet your needs, goals and aspirations.

Chapter 8 of this Manual also provides information about a range of different supports available to a diversity of people with psychosocial disability, as well as those living with a number of mental health conditions and other coexisting conditions and disabilities. It also provides information about access to services for older people with disabilities and mental health conditions here.

If the impact of your disability increases over time and is significantly impacting your day-to-day living, or you develop a new impairment, you can make a new access request with the NDIA as they make their decisions based on the current impact of your disability.

Alternatively, if you disagree with the decision that you are ineligible to access the NDIS, you can seek a formal review, outlined here.

12C.6: Do I have to prove that I have a psychosocial disability?

While no diagnosis of a mental health condition is required to be eligible for NDIS funding, you will need to provide evidence of how your psychosocial disability affects your day-to-day living. This means that you are a person living with a mental health condition that affects or reduces your ability to function, think clearly, experience full physical health and need support with social and emotional aspects of life (permanently or on an episodic basis).

The information supporting your application to the NDIS should include details describing your disability, the treatments you receive, the daily impacts of your disability on your life, and how long it is expected to last. Supporting evidence must be less than twelve (12) months old and can include:

  • a letter from a health professional, support person, or family member;
  • a completed assessment from a health professional such as a general practitioner, occupational therapist, psychologist, psychiatrist or social worker; or
  • other reports from your treating health professional, support service, or family member.

It is helpful if the treating health professional who provides the evidence of your disability is the most appropriate person to provide evidence of your primary disability, and has treated you for a significant period of time (e.g. at least six months). This health professional will not be able to tell you if you meet the NDIS requirements, only the NDIA can make this decision.

If you do not have any recent evidence, or your evidence doesn’t provide enough detail, you may be asked to complete a Supporting Evidence Form. It has a section to be completed by a health professional about your impairments and the supports you need. An example of a completed Supporting Evidence Form has been provided on the reimagine.today website.

If you would like help in collecting your supporting evidence, Local Area Coordinators are available to assist with this.

12C.7: The role of General Practitioners in the NDIS

General Practitioners are often the first point of contact for people living with disabilities and their families. They have an important role in supporting people access the NDIS.

Responsibilities of general practitioners include:

  • helping their patients to understand the NDIS particularly:
    • people who have limited community connections and support outside of their general practitioner;
    • people living in rural and remote areas; and
    • people from diverse cultural backgrounds;
  • setting expectations for patients about the likelihood of funding (Note: GPs cannot tell you for certain whether you will meet the eligibility requirements or not);
  • explaining the responsibilities of the NDIS compared to the mainstream health services;
  • supporting a patient’s NDIS access request by:
    • Completing the supporting evidence section of the Access Request Form;
    • Documenting that they have or are likely to have a permanent disability; and
    • Providing copies of reports or assessments relevant to the diagnosis/condition that outlines the extent of the functional impact of the disability.

General practitioners will not automatically receive your NDIS plan. It is useful to provide it to your regular general practitioner so that they are aware of what supports you’re receiving and so they can also gain a better understanding of what supports NDIS participants can receive.

If you are a general practitioner or allied health profession, the following are useful preliminary resources:

Updated November 20, 2020