Getting access is tough right now. Growth of the Scheme has been slowed, and people with less straightforward conditions often face multiple refusals. For many, though, the NDIS is the only realistic path to an ordinary life. If you do get access and your first plan is tiny, that is common. There are options to build from there, which we cover in a separate guide.
Two official links to start with:
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Disability requirements and thresholds: https://www.ndis.gov.au/participants/who-can-apply/what-are-ndis-access-requirements
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Lists of conditions (List A and List B): https://www.ndis.gov.au/participants/who-can-apply/information-for-health-professionals/list-conditions
What the NDIS is, and who you apply to
The National Disability Insurance Scheme (NDIS) funds reasonable and necessary disability supports. You apply to the National Disability Insurance Agency (NDIA). If approved, you become an NDIS participant and receive a plan that funds your disability supports.
The core test in plain language
You meet the disability rules when evidence shows that:
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You have an impairment that is likely to be permanent.
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That permanent impairment substantially reduces functional capacity in one or more areas like mobility, communication, learning, social interaction, self-care or self-management.
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Your impairment affects social or economic participation, and you will need NDIS-type supports long term.
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No appropriate, evidence-based treatments are likely to remedy the impairment.
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Important: it is the functional impairment that must be permanent, not just the diagnosis.
Use the Lists to check severity thresholds
Some diagnoses only meet the rules at certain severities.
Examples:
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Autism: generally Level 2 or Level 3 under DSM-5 meets the List A threshold.
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Permanent blindness: there are specific thresholds for corrected vision or field loss that must be met in both eyes.
If your condition is on List B, it is likely permanent, but you still need to show that your functional impairment meets the disability requirements.
Baseline, not flare-ups
The NDIA generally funds your baseline, not short-term flare-ups. For conditions like fibromyalgia or bipolar, reports should describe how things are on your harder, typical days, not only your best days. Do not hold back on describing regular impacts.
Who needs to say what
Your own statement helps for context, but the NDIA gives the most weight to clear letters or reports from qualified professionals. The content below should be in clinician reports (GP, specialist, OT, psychologist, physio, speech):
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Diagnosis and permanence of the impairment.
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Functional impacts at your baseline using everyday tasks, with frequency, duration and intensity of help required.
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Treatments considered or tried, and why none are likely to remedy the impairment.
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Which disability activities are substantially reduced, and the resulting support needs with realistic frequencies and durations. Clear support needs give you a better chance that the first plan is not bare-bones.
Do not assume clinicians know NDIS expectations. Read drafts constructively. If something is vague or overly positive, ask for amendments.
Practical tip: it is often a good idea to ask your GP to complete the NDIS Access Request form, and attach key specialist and therapy reports.
Step-by-step: applying for access
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Ask your GP to complete the NDIS Access Request form, with supporting specialist and therapy reports attached.
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Collect targeted evidence before you submit. In straightforward cases, one strong clinician letter can be enough. In complex cases, a larger, well organised bundle is appropriate.
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Submit the Access Request to the NDIA with your evidence. Keep copies of everything.
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Respond precisely to any follow-up questions from the NDIA.
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If refused, request an internal review within three months and strengthen the evidence that addresses the reasons for refusal.
A note on timing if you use public health services: if you are a pensioner or rely on the public system for reports, getting appointments and letters can take a long time. You may be without supports during that wait. It is frustrating, and you are not alone.
Why many people are declined at first
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Diagnosis not clearly confirmed or permanence not stated. You need both diagnosis and permanence.
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Functional impact not shown well enough alongside the diagnosis. Both are required.
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Treatments not addressed or unclear why improvement is not expected.
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List thresholds not met for the named condition.
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Reports too positive or vague, not reflecting your typical baseline.
Examples of what this looks like in reports
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Autism (adult): Clinical psychologist confirms ASD Level 2 and maps impacts across self management and social interaction. OT outlines weekly support needs and risks when unsupported.
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Vision impairment: Ophthalmologist confirms permanent thresholds are met in both eyes and describes functional impacts. Orientation and mobility specialist outlines support needs for community access.
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Bipolar: Psychiatrist confirms permanence, treatment adherence and enduring functional impairment across self management and social interaction, described at baseline.
If your first plan is very small
It happens. Use what you can. Ask providers to document the gaps and risks in short letters, then prepare for reassessment with stronger, targeted evidence.
A gentle offer of support
If you are struggling, feel free to reach out to our team. If Meliora cannot help, we can help direct you to a disability advocate in your area.
Bottom line: understand the thresholds, get clinician evidence that proves permanent functional impairment and spells out real support needs, submit a complete Access Request, and be ready to review if needed.