How Does The NDIS Work? How Do I Apply For Support?

The National Disability Insurance Scheme (NDIS) supports Australian people with disability.

Rolled out in 2019, it was created after a productivity commission revealed the country’s disability system was ‘underfunded, unfair, fragmented and inefficient‘.

Accordingly, the government acknowledged these concerns and reformed the entire setup. The result is flexible, individual funding packages that support approved NDIS participants.

However, not all Australians with a disability are eligible for this scheme.

The NDIS Commission has a stringent applicant process that potential participants must complete. This helps ensure services reach those who need them most. It also maintains integrity within this potentially life-changing scheme.

Eligibility for the NDIS

The NDIS provides supports to children and adults who meet NDIS eligibility criteria. These requirements clarify which people with disability are eligible to receive funding.

To apply, you must be:

Age

Under the age of 65

Residency Status

Living in Australia as an Australian citizen or permanent resident. Or, you can live in the country and have a:

• permanent visa, or
• protected special category visa.

Disability Requirements

Living with a disability caused by permanent impairment that impacts physical or mental health. To expand further, this includes intellectual, cognitive, neurological, sensory, or psychosocial disability. 

Essentially, participants regularly need disability support to complete daily life activities.

Preparing for Your NDIS Application

Preparing for an NDIS application requires organisation. That’s because there are many factors to consider, which is why collecting information for your application form can take time.

Age

Gathering documents and evidence to support your claim is critical for preparation. With this in mind, ensure it shows evidence of disability and how it impacts your everyday activities. Everything needs to satisfy a set of eligibility questions and parameters.

Types of identity documents you need to provide include:

• personal identification documents
• evidence of residence
• income
• medical records
• diagnosis reports
• assessments by health practitioners. If you already have a carer, showing carer evidence is also useful.

Ensure all documents are up-to-date and accurate. Double check application details before you’re complete. This helps avoid application delays or complications with the online application form process.

Support

Seeking guidance from relevant professionals or support networks is recommended.

This may include talking to your doctor, healthcare provider or disability support services. You can also connect with an NDIS planner to help you understand the application process.

The NDIS Access Request Form

The NDIS Access Request Form is the first step to accessing NDIS-funded support.

It involves submitting an application to the National Disability Insurance Agency (NDIA). This is the Australian government body who oversees the NDIS.

Step 1

To begin, an individual or their representative must contact the NDIA. You can do this via phone or using their email address.

The NDIA will describe access requirements, the application process and necessary documentation. Think of this as your own personal application guide.

Step 2

The next step is to complete the NDIS Access Request Form. Find it on the NDIA website or ask for it at your local NDIS office.

This form includes information about the applicant’s personal details, disability, and support needs. It also highlights an applicant’s goals and aspirations.

You must provide evidence to support the application.

Step 3

Once completed, submit the Access Request Form and supporting evidence to the NDIA. You can do this via mail (Australia Post), email or manual collection at a local NDIS office.

Step 4

The NDIA reviews everything to decide if you are eligible.

If successful, you will receive a letter or confirmation email with the next steps. This involves the NDIA working with you (or a legal guardian) to develop a plan for support.

If unsuccessful, you can request a review of the decision.

Understanding the NDIS Planning Meeting

The NDIS planning meeting is a crucial part of the funding process for participants.

This face-to-face meeting involves the participant and an NDIS representative. Discussions focus on the participant’s:

1. disability-related needs
2. functional capacity
3. challenges, including difficulty with activities on a daily basis
4. goals
5. current support arrangements
6. gaps or limitations in existing services.

Then, a personalised plan is created. Within it are the funding and support needed to improve the participant’s quality of life.

The NDIS representative will explain all available options. This relates to individualised funding packages, support coordination, and other services.

Participant Planning Tips

Some tips for preparing for the NDIS planning meeting include:

• Create a list of goals and support needs
• Gather identity documents, including a photo identity card
• Collect medical information requested
• Have your diagnosis of disability from a health service provider
• Bring a support person or advocate to the meeting
• Be clear and concise when discussing support requirements
• Ask questions and seek clarification when needed
• Be prepared to negotiate and advocate for specific support needs
• Review and update the plan regularly.

Receiving Your NDIS Plan

Every approved NDIS participant receives an NDIS plan. It’s developed based on the participant’s individual circumstances, needs and preferences.

The NDIA sends a letter or email advising the participant of their approved plan.This outlines the support and funding available.

There are 3 types of NDIS funding management options:

Self-managed

NDIS self-managed participants manage their own funding. This includes selecting and paying for their support providers.

They can use NDIS registered and unregistered providers for most services.

Plan-managed

Plan-managed participants work with a plan manager to manage their funding and support providers. 

They can also use unregistered and registered providers for most of their services.

NDIA-managed

The NDIA manages the participant’s funding and pays support providers directly. They may only choose from registered providers.

Making Your Decision

Participants can choose the funding management option that best suits them.

It is, however, important to know each option has advantages and disadvantages. That’s why participants must carefully consider their options before making a decision.

Where possible, it’s encouraged to become a plan-managed or self-managed NDIS participant. This is because they can access a range of services from many providers – registered and unregistered.

While they have the most freedom, there are some limitations. These plans can only access registered NDIS providers for these categories of workers:

• specialist disability accommodation settings
• supports or services related to a regulated restrictive practice
• some specialist behaviour supports.

Worker Screening Checks

Registered providers are considered gold-standard.

They have completed a rigorous online application and the NDIS Worker Screening Check. A worker screening clearance helps optimise delivery of services to people with disability. It is mandatory for:

• registered providers
• key personnel
• contractors/employees. 

Unregistered Providers are strongly encouraged to engage workers that have obtained the NDIS Worker Screening Check.

Both registered and unregistered providers must provide exceptional support and always minimise risk of harm.

Tips for a Successful NDIS Application

Here are tips that will help you create a successful NDIS application:

Have thorough documents, evidence and records

Successful NDIS applications contain detailed and accurate information about the participants’ disability needs.

Make sure to document all your symptoms, limitations, and requirements.

Have medical reports and assessments from medical professionals, and proof of identity documents, on-hand.

Make contact with people who can support your claim, such as a social worker. Ask them for what you need. The more details you have, the better.

Clearly outline support & health needs

Be particular when outlining your support needs in the application.

Include things like therapy, equipment, personal care, and transport requirements. Also include any other support services that help you manage your disability.

Don’t be shy in listing the emotional impact and functional impact these have for you.

Provide a clear list of benefits to help the NDIS Commission understand your needs.

Use professional services

Get professional help if you find the application process overwhelming.

NDIS providers, support coordinators and social workers can guide you.

They can assist with the application, gathering documents and navigating the process. They’ll also help you understand all of your support options.

If you’re deaf or find it hard to hear or speak with people on a phone, use the National Relay Service for support.

Be patient

The NDIS application process can take time. Be patient, persistent and stay optimistic.

While time frames vary, it can take several months for application reviews.

It can take even more time if extra information is requested, which may happen if you haven’t met all criteria on the eligibility checklist.

Keep in mind that the NDIS provides long-term support, so it’s worth taking the time to get the application right.

When everything has been reviewed, you will receive a letter or email confirming whether you have been successful.

Be prepared to appeal

Despite your best efforts, your application may be rejected. Or, the level of support offered may be insufficient.

If this happens, you can appeal the decision. Be prepared to provide extra documentation and evidence to support your case. Don’t give up!

What to Do If Your NDIS Application Is Denied

Applications for people wanting NDIS funding can be approved or denied.

Unsuccessful applicants can get frustrated, especially if they feel genuinely entitled to support. However, other supports are available for those who aren’t eligible for the NDIS.

Was your NDIS application denied?

The good news is you have the right to request a review of the decision. The NDIS review process challenges NDIA decisions regarding eligibility for support.

Here are the steps to take if you receive a ‘NDIS application denied’ notification:

1. Understand the reasons for denial

The first step is to understand why your application was denied. The NDIA will provide you with a letter explaining the decision and the reasons behind it. Take time carefully to read and comprehend the letter.

2. Share new evidence

Got new evidence about your disability or how a developmental delay affects your daily life? Use it, as this may change the NDIA’s decision.

Consider completing a new access request form and sharing additional documents.

3. Request an internal review

If you disagree with the decision, you have the right to request an internal review. This means that your application will be re-assessed by a different NDIA representative.

You must request this review within three months of receiving the decision letter.

4. Prepare for the review

Gather extra information or evidence that may support your application, such as:

• medical reports
• letters from health professionals
• statements from family and friends. 

Have a clear understanding of the NDIS eligibility criteria and how your situation meets it.

5. Attend the review meeting

The internal review process involves a meeting with a new NDIA representative. This can occur in person, over the phone, or via video conference.

You’ll have the opportunity to present new information or evidence.

The representative will ask questions to clarify your situation.

6. Await the outcome

After the review, the NDIA will provide you with a decision in writing.

If your application is approved, you will receive a plan outlining the support you can access.

A federal administrative review body can assist if your application is still denied.

Note: The Administrative Appeals Tribunal (AAT) used to offer ongoing monitoring in this situation. This is no longer the case.

Conclusion

The NDIS is a voluntary scheme that funds people with permanent or significant disability.

Recipients of this Australian government benefit are called participants.

To do this, submitting an NDIS Access Request Form is essential. As is attending a planning meeting. Then, if your application is unsuccessful, you may appeal the process.

Approved NDIS participants access approved services from disability support workers, also known as NDIS providers.

They’re expected to offer a consistent approach to support. Plus they ought to have risk management strategies in place.

Together, this helps strengthen rapport with people receiving NDIS funding. It also maintains integrity of the scheme in the long term.

If you need further help applying for the NDIS, visit the National Disability Insurance Scheme website.