Intellectual Disability and eligibility for NDIS funding?

If you have been diagnosed with an intellectual disability or have a condition that results in a permanent impact to your cognitive function, 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? 

The NDIA explain this is when your capacity to complete a task as easily or quickly as “normal” is reduced due to your intellectual disability.

What is “normal”?

This describes how your intellectual disability impacts your capacity to complete a task compared to people of a similar age and demographic who do not have an intellectual disability.

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

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

Intellectual Disability is included in Condition List A, where it confirms NDIS eligibility for: Intellectual disability diagnosed and assessed as moderate, severe or profound in accordance with current DSM criteria.

Also included in Condition List A for NDIS eligility is a range of genetic conditions that consistently result in permanent and severe intellectual and physical impairments. Please refer to the Condition List A for further details.

NDIS Condition List B

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. 

Included in Condition List B are conditions primarily resulting in intellectual or learning impairment. The conditions listed include:

• Intellectual disability
• Pervasive developmental disorders not meeting severity criteria in List A or List C, such as autism
• Asperger syndrome
• Atypical autism
• Childhood autism

Also included in Condition List B are conditions where chromosomal abnormalities resulting in permanent impairment and not specified on List A. Please refer to the Condition List B for further details.

Evidence of Intellectual Disability for NDIS Eligibility

When applying to the NDIS, evidence of having an intellectual disability or condition that results in intellectual or learning impairemnt will be required, as outlined in Condition List A and B.

Due to List B including conditions that are likely to result in a permanent impairment, the NDIA state that 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.

What evidence is required for my Intellectual Disability for the NDIS?

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 intellectual disability.

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 intellectual disability 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 intellectual disability 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 your intellectual disability results in a physical impairment over the span of your life and 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 intellectual disability 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 intellectual disability impacts your functional capacity across the eligibility categories listed above.

If you do engage with an OT, the assessment is typically called an NDIS Access Assessment and you will be provided an NDIS or OT Access Assessment Report. Your OT may describe the assessment and report as something slightly different.

The report will link any impairment you experience across the eligibility criteria to your intellectual disability.

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 completed following an OT assessment. You cannot recieve a report without undergoing an 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 intellectual disability 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)