You know what you need, but the NDIA needs proof. The path is clearer when you speak their language and show how the support works in your day-to-day life.
What the NDIA is actually checking
In plain English, decision makers look for whether a support:
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relates to your disability and the way it affects daily life
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is effective and beneficial for you
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is practical and value for money compared with other options
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is not the responsibility of another system such as health or education
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takes into account informal supports and whether they are sustainable
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helps you pursue your goals and participate safely
Your evidence should answer each of these points directly.
Baseline, not flare-ups
The NDIA generally funds your disability “baseline”, not temporary flare-ups. For many conditions like fibromyalgia or bipolar, that means funding is based on how you function on your harder, typical days, not your best days or brief spikes. We suggest using your harder days as the baselinewhen reports describe your functional impacts.
Why this matters:
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Flare-ups are often treated as health-system issues.
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If your baseline is described as “mostly fine” with a few bad patches, funding is likely to be reduced.
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Do not hold back when describing impacts that occur regularly or predictably.
There is a bigger conversation needed across the disability community about a fair definition of “baseline”, especially while the Agency underfunds so often. For now, make sure reports reflect the reality you live with most of the time.
Clinician reports make or break decisions
What you say matters, but it carries limited weight on its own. The NDIA relies on qualified professional evidence in clear letters or reports. Your own impact statement helps provide context, but it is not enough without professional backing.
Do not assume your OT, GP, physio, psychiatrist or other clinicians know how to write to NDIA standards. Read drafts constructively and critically. If something is vague or upbeat without detail, ask for amendments. If you have a support coordinator, involve them to align evidence across providers.
Meliora tip: We have practical report-writer guides that show exactly what the NDIA looks for. If you’d like those templates and a quick sense-check, feel free to reach out.
Build your proof, point by point
1) Link to disability and functional impacts
Describe your typical baseline, including the harder parts of your week. Be specific about where you need help, how often, and for how long.
Include
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a clinician letter naming diagnoses and explaining functional impacts
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practical examples from daily routines where things break down
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frequency, duration and intensity of support needed
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safety issues such as falls, pressure injuries or medication errors
Example
Showering: without a level-access shower and one worker, transfers require two people for 45 minutes with slip risk. With the modification and one worker, transfers are safe in 15 minutes.
2) Tie the support to goals and outcomes
Connect the support to outcomes in your plan, not just to a diagnosis.
Include
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the goal the support serves
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a short outcome statement, for example “two mornings per week of safe personal care so I can attend therapy and community without missing medication”
3) Show it is effective and beneficial for you
Point to evidence that it works for you. Trials help.
Include
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trial notes or short progress data
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clinician opinion on why this option fits your environment and risks
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why previous approaches failed, if relevant
4) Prove value for money and consider alternatives
Show why this is the most practical and cost-effective way to meet the need.
Include
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two quotes where possible
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a brief comparison of options and ongoing costs
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where relevant, a multi-year cost view comparing equipment to ongoing worker hours
Example
Powered wheelchair vs extra support hours: OT sets out five-year purchase and maintenance costs and compares them to weekly worker time needed to push and position safely.
5) Clarify the boundary with other systems
Make it clear the request is not something that should be funded by health, education or housing, and not attributable to another health condition the NDIS does not fund.
Include
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a short note from the relevant professional confirming it is not a health treatment or school cost
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where multiple conditions exist, explain why this support is required because of your disability
6) Be honest about informal supports and sustainability
Explain what family or friends can realistically do and what they cannot sustain.
Include
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a carer statement about capacity, hours and limits
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any risks of burnout or work impacts
7) Check it fits current NDIS rules and lists
If the item sits on the NDIS supports lists, say so. If it does not, consider whether a replacement support pathway applies and explain how a standard item directly replaces a more costly disability-specific support.
Common pitfalls and how to avoid them
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Vague or upbeat language that hides risk. Replace with concrete examples and numbers.
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Inconsistent reports. Align terminology and frequency across disciplines.
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No cost comparison. Always show why your option is the practical, value-for-money choice.
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Asking for something outside the lists. If the rules have shifted, consider an alternative or a replacement support and explain the trade-offs honestly.
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Participant statement only. Ensure a qualified professional provides the core evidence.
Real-world scenarios
Assistive technology upgrade
Problem: manual chair causes shoulder pain and limits community access.
Proof: OT shows distance and terrain in your area, failed trials with power-assist wheels, two quotes for a powered chair, and a five-year cost comparison against worker time. Outcomes are distance, fatigue rating and appointments attended.
Support coordination reinstatement
Problem: coordination removed despite multiple providers and barriers with planning and memory.
Proof: psychologist describes executive functioning limits; coordinator log shows missed appointments and clashes without coordination; outcome is safe scheduling and tenancy stability.
Home modification for safe showering
Problem: step-in shower causes near falls and requires two workers.
Proof: OT maps task demands to your mobility and balance, compares portable equipment to a level-access shower, sets out cost, risk, and time saved per week, and links to the personal care goal.
If the NDIA says no
You may ask for an internal review within three months of receiving the decision in writing. Because many internal reviews uphold the original decision, submit targeted new evidence that answers the NDIA’s reasons directly. If funding periods limit what you can do while waiting, operate as safely as you can within the decision and document the impacts through short notes from your practitioner. If the internal review still confirms the decision, the Tribunal is the next option and we cover that in a separate guide.
Bottom line
Proving “reasonable and necessary” is about answering the NDIA’s checks with clear, professional evidence that reflects your real baseline. Map each point to a document, keep the language plain, and show why your option is both effective for you and sensible for the Scheme.