The National Disability Insurance Scheme (NDIS) has undergone a series of legislative and operational reforms culminating in the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Act 2024, which received Royal Assent on 22 August 2024. For permanent residents living with disability, the pathway to accessing reasonable and necessary supports now operates within a tightened framework of eligibility assessment, needs-based budgeting, and clearer definitions of NDIS-funded supports versus mainstream service obligations. The National Disability Insurance Agency (NDIA) released the updated Access to the NDIS Operational Guideline on 3 October 2024, which is the current reference point for all access decisions. These changes directly affect when and how a permanent resident can become a participant, what evidence is required, and how impairment severity is measured against the access criteria. The shift toward a functional impairment model, rather than diagnosis alone, means that holding a permanent residency visa and having a diagnosed disability does not guarantee scheme entry. The NDIA now applies a standardised assessment tool for certain age cohorts and impairment types, and the concept of “NDIS supports” has been legislatively narrowed to exclude day-to-day living costs that are the responsibility of the health, education, or housing systems. This article sets out the access requirements as they stand under the amended National Disability Insurance Scheme Act 2013 and the operational guidance effective from October 2024.
Residency and Visa Status Requirements
Permanent Resident Definition Under the NDIS Act
Section 29 of the National Disability Insurance Scheme Act 2013 requires that a person meet the residency requirements to become a participant. A permanent resident for NDIS purposes is the holder of a permanent visa as defined by the Migration Act 1958. This includes individuals who have been granted a Permanent Resident visa (subclasses such as 100, 189, 190, 801, and others) and are residing in Australia. The NDIA Operational Guideline – Access – Residency, updated 3 October 2024, specifies that the person must live in Australia on the day the access decision is made and must be an Australian citizen, a permanent visa holder, or a Protected Special Category Visa holder (Department of Social Services, NDIS Operational Guideline – Residency, 3 October 2024).
A permanent resident who is outside Australia at the time of the access request will not satisfy the residence requirement. The person must be physically present in Australia. Temporary visa holders, including those on bridging visas or temporary graduate visas (subclass 485), are not eligible regardless of the length of their stay or their disability status. Newly arrived permanent residents are not subject to a waiting period for NDIS access; there is no minimum residency duration imposed by the Act, unlike some Centrelink payments administered by Services Australia.
Age Requirements
The person must be under 65 years of age at the time of the access request. Section 22 of the Act sets the age ceiling. A permanent resident who acquires a disability after turning 65 is directed to the aged care system, specifically the Commonwealth Home Support Programme or a Home Care Package, through My Aged Care. The NDIS does not accept access requests from individuals aged 65 or over, even if they meet all other criteria. For those who become participants before age 65, they can choose to remain with the NDIS after turning 65 rather than transitioning to aged care.
Disability and Early Intervention Requirements
The Two Pathways: Disability Requirements and Early Intervention Requirements
The Act provides two distinct access pathways under sections 24 and 25. A permanent resident must satisfy either the disability requirements or the early intervention requirements, not both. The disability requirements (section 24) demand that the person has a disability attributable to one or more intellectual, cognitive, neurological, sensory, or physical impairments, or a psychiatric condition. The impairment must be, or is likely to be, permanent. The permanency criterion means that there are no known, available, and appropriate evidence-based clinical treatments that would remedy the impairment. The NDIA Operational Guideline – Access – Disability Requirements, effective 3 October 2024, states that an impairment is permanent if it is “likely to be lifelong” and the person will “require support under the NDIS for their lifetime” (NDIA, Access to the NDIS Operational Guideline, 3 October 2024).
The impairment must result in substantially reduced functional capacity to undertake one or more of the following activities: communication, social interaction, learning, mobility, self-care, or self-management. The term “substantially reduced” is not defined by a percentage but is assessed against what a person without the impairment could reasonably be expected to do. The NDIA considers the frequency, intensity, and type of support required. The impairment must also affect the person’s capacity for social or economic participation, and the person must be likely to require support under the NDIS for their lifetime.
The early intervention requirements (section 25) apply where a person has an impairment that is, or is likely to be, permanent, or is a developmental delay in a child under 6 years of age. Early intervention supports must be likely to reduce the person’s future need for supports, improve functional capacity, or strengthen informal supports. The NDIA does not require that functional capacity be substantially reduced under this pathway. The provision of early intervention supports must be most appropriately funded through the NDIS and not through another service system.
Evidence Requirements
The NDIA access request form requires evidence from treating health professionals. The Operational Guideline specifies that evidence must confirm the presence of an impairment, describe whether the impairment is permanent or likely to be permanent, and explain the functional impact across the six activity domains. The NDIA accepts reports from general practitioners, medical specialists, allied health professionals (occupational therapists, physiotherapists, speech pathologists, psychologists), and, for psychiatric conditions, a psychiatrist or a clinical psychologist. A diagnosis alone is insufficient. The report must describe treatment history, including any interventions tried and their outcomes, to support the permanency finding. For children under 7 with developmental delay, a paediatrician or a multidisciplinary team report is preferred.
The NDIA introduced a standardised functional assessment process for certain cohorts under the reforms. From October 2024, independent assessments are not mandated across all access requests, but the NDIA may request a functional capacity assessment using an approved tool where existing evidence is insufficient. The assessment is arranged and funded by the NDIA.
What the NDIS Funds: The New Definition of NDIS Supports
Section 10 and Section 34 Amendments
The National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Act 2024 inserted a new section 10 into the Act, which defines “NDIS supports” as supports that are “directly related to the person’s disability” and are not more appropriately funded or provided through other service systems. The amendments also introduced a new section 34 that requires the NDIA to prepare a “needs assessment” for each participant that identifies the person’s disability-related support needs and specifies which of those needs will be met by the NDIS. This replaced the previous reasonable and necessary framework that operated without a legislated list of exclusions.
From 3 October 2024, the NDIS does not fund day-to-day living costs that are not attributable to a person’s disability support needs. This includes rent, mortgage payments, groceries, utility bills, and general household items. The NDIS also does not fund supports that are the responsibility of the health system, such as acute medical care, medications listed on the Pharmaceutical Benefits Scheme, or hospital treatment. Education-related supports that are the obligation of state and territory education departments, including teachers’ aides for classroom learning, are excluded unless the support is directly required due to the impact of the person’s disability and is not the responsibility of the education system. The NDIA published a transitional list of “NDIS supports” and “non-NDIS supports” on its website, effective 3 October 2024, to guide participants and providers (NDIA, What Does the NDIS Fund?, 3 October 2024).
Needs-Based Budgeting and Plan Flexibility
The amended Act requires that participant plans specify a total budget amount and describe the supports to be funded. The plan must be based on the needs assessment. Participants have flexibility within their plan to use funding across the identified support categories, but they cannot use NDIS funds to purchase items or services that are not NDIS supports. The NDIA’s myplace portal reflects these categories. Plan reviews are triggered by a change in circumstances, a scheduled review date, or a participant request. The NDIA may conduct a mid-plan review if there is evidence that the funded supports are not meeting the participant’s needs or if the participant’s circumstances change materially.
Interaction With Mainstream Services and Medicare
Health System Interface
The NDIS does not replace Medicare or state-funded health services. A permanent resident with disability continues to access Medicare for general practice, specialist consultations, diagnostic imaging, and pathology. The NDIS funds disability-related supports that enable the person to access health services, such as transport to medical appointments or a support worker to attend a consultation, where this is directly related to the person’s disability. The NDIS does not fund the clinical treatment itself. The Department of Health and Aged Care and the NDIA jointly released the NDIS and Health Interface – Principles document in September 2024, which clarifies that health services remain the responsibility of the health system even where the person has an NDIS plan.
Mental Health and Psychosocial Disability
Permanent residents with psychosocial disability arising from a mental health condition must meet the same access criteria as those with physical or intellectual impairments. The NDIA requires evidence that the psychosocial disability is permanent and results in substantially reduced functional capacity. Clinical treatment for the mental health condition, including psychiatric care, psychological therapy, and medication, is funded through Medicare (Better Access initiative, Medicare Benefits Schedule items) and state mental health services. The NDIS funds supports that assist with daily living, social participation, and community access where these needs arise from the psychosocial disability and are not clinical in nature. The NDIA Operational Guideline – Access – Psychosocial Disability, updated October 2024, provides specific guidance on evidence requirements, including the need for a diagnosis from a psychiatrist and a functional assessment addressing the six activity domains.
How to Apply for NDIS Access
Access Request Process
A permanent resident can make an access request by contacting the NDIA on 1800 800 110, completing an Access Request Form (ARF), and submitting supporting evidence. The ARF is available on the NDIS website and can be submitted by email, post, or in person at an NDIA office. A local area coordinator (LAC) or an early childhood partner can assist with the application. The NDIA must make an access decision within 21 days of receiving a complete access request. If further information is required, the NDIA will request it in writing and the decision timeframe pauses until the information is provided.
The access decision is a reviewable decision under section 100 of the Act. A person whose access request is refused can request an internal review by the NDIA within three months of receiving the decision notice. If the internal review affirms the refusal, the person can apply to the Administrative Review Tribunal (ART) for external merits review. The ART replaced the Administrative Appeals Tribunal on 14 October 2024.
Supporting Evidence Checklist
The NDIA recommends that evidence include: a completed ARF with the person’s details and consent; a report from a treating health professional that describes the impairment, its permanency, and its functional impact; any relevant diagnostic reports, test results, or hospital discharge summaries; and for children, a developmental assessment. The evidence must be current, typically within the last two years, though older evidence may be accepted for lifelong conditions where the functional impact is stable. The NDIA does not charge a fee for the access request.
Actionable Takeaways
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Verify your visa status against the permanent visa subclasses listed by the Department of Home Affairs before making an access request. Temporary visa holders are not eligible, and the NDIA checks visa status electronically through Department systems.
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Obtain a functional capacity report from a treating health professional that addresses the six activity domains (communication, social interaction, learning, mobility, self-care, self-management) and explains why the impairment is permanent despite any treatments undertaken. A diagnosis letter alone will result in a request for further evidence or a refusal.
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Check the NDIA’s “What Does the NDIS Fund?” list before developing a support plan with a planner or LAC. Items such as rent, groceries, and clinical health services are explicitly excluded, and requesting them may delay plan approval.
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If an access request is refused, request an internal review within the three-month statutory timeframe. The internal review is free and preserves the right to apply to the ART. Keep copies of all submitted evidence and the refusal notice.
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For children under 7 with developmental delay, engage an early childhood partner through the NDIS early childhood approach. This pathway does not require a formal diagnosis and can provide early intervention supports while evidence for a permanent impairment is being gathered.