Accessing the NDIS with an Acquired Brain Injury

What is an Acquired Brain Injury?

An acquired brain injury (ABI) is the result of damage to your brain.

This can involve trauma to the brain, or be a result of a stroke, drugs, alcohol or poisons, lack of oxygen to the brain, infection or tumor.

An acquired brain injury may be a result of a neurodegenerative condition, such as Parkinson's disease or dementia.

Acquired Brain Injury and the NDIS

Some interesting facts...

• 3% of the 610,502 active participants in the NDIS have a primary disability of an acquired brain injury
• Over the past year, 80% of acquired brain injury NDIS applications were successful
• The number of participants with an acquired brain injury has increased by 12% and 8% in the last two years
• $138,600 was the average payment per participant with an acquired brain injury in 2023. This has increased by 15% since the year before
• 15% of participants with an acquired brain injury had SIL funded in their NDIS plan throughout 2023 

In summary, funding for brain injury is on the rise. More Autralian's with an acquired brain injury are accessing the services they need to achieve their goals.

Acquired Brain Injury and eligibility for NDIS funding?

If you have a brain injury that has resulted in permanent functional impairment, you may be eligible to the NDIS.

The NDIS has eligibility criteria for people applying to the NDIS. You are eligible for NDIS funding if you meet the following NDIS Access Criteria:

• You are aged between 9 and 65 years
• You are an Australian citizen, permanent resident, or Protected Special Category Visa holder
• You live in Australia
• You have a disability caused by a permanent impairment (lifelong disability)

What is impairment? When your capacity to complete a task as easily or quickly as “normal” is reduced due to your acquired brain injury.

What is “normal”? This is how you may have completed the task prior to acquiring your brain injury, or how people of a similar age and demographic who do not have a brain injury may complete a task.

See Who is eligible for the NDIS? for further information on NDIS eligibility criteria.

NDIS Eligibility Criteria

Within the NDIS eligibility requirements, there are two lists of conditions for NDIS eligibility - Condition List A and Condition List B.

NDIS Condition List A includes conditions that are likely to meet the disability eligibility requirements for people seeking to access the NDIS. 

Brain Injury is included in Condition List A, however there is no further information or details regarding any specific condition that is classified as a brain injury by the NDIA.

NDIS Condition List B is the second list which outlines conditions that are likely to result in a permanent impairment. If the presence of a permanent impairment can be established, then the application will likely meet the disability eligibility requirements. 

The following conditions included in Condition List B are considered acquired brain injuries:

• Alzheimer’s dementia
• Vascular dementia
• Parkinson’s disease
• Brain stem stroke syndrome
• Cerebellar stroke syndrome
• Hydrocephalus, which can in some cases be caused subsequent to a brain injury

There are other types of brain injury not included in this list. However, this does not mean that you are unable to access the NDIS.

When applying to the NDIS, evidence of having a brain injury will be required for conditions stated in both List A and List B. 

Due to List B including conditions that are likely to result in a permanent impairment, further evidence is required to establish that the impairment is considered lifelong. 

Remember, a permanent impairment resulting in a lifelong disability is typically funded by the NDIS. 

If your condition is not considered permanent or lifelong, the NDIS may not be right for you. If this is the case, there may be alternative services and funding available to you through the health system or other departments or agencies.

Evidence of Acquired Brain Injury for NDIS Eligibility

When providing evidence to access the NDIS, you will have the best chance for success if you provide information on your permanent impairment, and how it substantially reduces your functional capacity or ability to undertake activities in one or more of the following areas:

Communicating

This involves how you speak, write, or use sign language and gestures to express yourself.
The NDIA considers how well you understand people and how others understand you, and how this is impacted by your brain injury.

Socialising

This involves how you make and keep friends, or interact with others the community.
The NDIA considers how you socialise with others, and also want to know about your behaviours and how your brain injury impacts your ability to cope with feelings and emotions in social situations.

Learning

This involves how you learn, understand and remember new things, and practice and use new skills.
The NDIA will consider how your acquired brain injury impacts your cognitive abilities, which impacts how you learn and interact with the world.

Mobility

This involves how you move around your home, transfer in and out of bed, transfer on and off the toilet, in and out of the shower etc. This also involves how you move around your community.
NDIA will consider whether you require use of a mobility aid or home environment modifications to help with your mobility.

Self Care

How do you manage your personal care needs? Maintain hygiene? Eat and drink? Get dressed? Go to the toilet?
The NDIA will require information about how you complete your self-care tasks, and how much help you need for these routines.

Self-Management

This involves how you organise your life - How do you plan? Make decisions? Look after yourself?

The NDIS considers your capacity to manage your life, involving your ability to problem solve and make your own decisions.

For further information regarding eligibility criteria, please review the 

NDIS Guidelines in Becoming a Participant

How do I know if I meet the NDIS eligibility criteria?

Of the activities listed above, you must be able to demonstrate impairment across one or more of these activities.

When you submit an application to the NDIS, it will be reviewed and you will be provided with an outcome if you have been successful or not in meeting the eligibility criteria to access the NDIS.

What do I need to include in my NDIS application?

To apply to the NDIS, you will need to complete an Access Request Form

As part of the access request process, you will be asked:

• to confirm your identity and/or a person's authority to act on your behalf
• questions to see if you meet the NDIS access requirements (age, residence and disability)
• questions about providing consent to enter the NDIS and about seeking information from third parties.

It is helpful to provide letters and reports from your treating health professionals with information regarding your acquired brain injury and the impact it has in your everyday life.

Do I need an Occupational Therapy (OT) report to access the NDIS?

While an OT report is not a requirement for an NDIS application, it is helpful to submit an OT report with your application as this will provide important information as to how your acquired brain injury impacts your functional capacity across the eligibility categories listed above.

The report will link any impairment you experience across the eligibility criteria to your acquired brain injury. The report may not provide specific recommendations for supports you require, but rather it should provide a broader recommendation as to whether NDIS-funded supports are necessary.

How do I get an OT report?

An OT report is completed following an OT assessment. Any assessments and reports completed prior to accessing the NDIS cannot be funded by the NDIS.

This assessment must be paid for privately. In some cases, you may be able to claim some of the cost through Medicare.

Does an OT assessment and report guarantee acceptance onto the NDIS?

No, as ultimately the decision is made by the NDIA. However, an OT assessment and report will be helpful in clearly demonstrating the link between your acquired brain injury and the functional impairment experienced. This is what the NDIA consider when making their decision.

Other treating health professionals can also provide complete a letter or report to assist with your application.

How do I find an Occupational Therapist for an assessment to access the NDIS?

The MyCareSpace Connections Team can help you to find an Occupational Therapist with capacity in your area or via online.

Find an Occupational Therapist
 

More information on how to access the NDIS

LINK: How to Apply for the NDIS

LINK: Writing an NDIS Carer Statement for NDIS Access and Reviews

LINK: Writing Reports for NDIS Access and Plan Reviews (Reassessments)