The question about whether someone with Autism automatically qualifies to receive NDIS funding is a common one.
How to qualify to receive NDIS funding for Autism
To become an NDIS participant, you must:
- Have a permanent impairment that significantly affects your ability to take part in everyday activities or have a developmental delay,
- Meet the NDIS disability requirements or early intervention requirements
- Be aged less than 65
- Be an Australian citizen or hold a permanent visa or a Protected Special Category visa
- Live in an area where the NDIS has rolled out
Does Autism automatically qualify for NDIS funding?
The latest version of the Diagnostic and Statistical Manual (DSM-5) categorises Autism Spectrum Disorder into 3 levels:
Level 1 – Requires Support
Level 2 – Requires Substantial Support
Level 3 – Requires Very Substantial Support
NDIS eligibility is based on reduced Functional Capacity in one or more of the following areas:
- Social Interaction,
- Self-Care and
Whilst a diagnosis of Autism at any level can meet the NDIS access criteria, the NDIA have Lists A-E to provide guidance in determining eligibility.
NDIS Funding Autism Level 2 or Level 3
Autism Level 2 and Level 3 are included in the NDIA's List A - Conditions which are likely to meet the disability requirements in section 24 of the NDIS Act
List A specifies: Autism diagnosed by a specialist multi-disciplinary team, paediatrician, psychiatrist or clinical psychologist experienced in the assessment of Pervasive Developmental Disorders, and assessed using the current Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnostic criteria as having severity of Level 2 (Requiring substantial support) or Level 3 (Requiring very substantial support).
With a Level 2 or Level 3 Autism diagnosis you are considered to have a permanent impairment of functional capacity and so the NDIS provides automatic access, no more assessments required.
What about NDIS Funding for ASD Level 1?
With a Level 1 diagnosis additional reporting and further substantiation is required as you will need to provide evidence of the impact autism has on your life, including any impact on your mobility, communication, social interaction, learning, self-care and self-management.
What Autism Assessments or Evidence is Required?
For each primary disability, the NDIS has stated which treating health professionals are the most appropriate to provide the standardised assessments that are considered "best practice" in evidence.
For Autism, these include:
- A member of a multidisciplinary team
- Occupational Therapist
- Speech Therapist
Disability evidence required (in preference order):
- Diagnostic and statistical manual of mental disorders, fifth edition (DSM-V) - this is the preferred report
- Vineland adaptive behaviour scale (Vineland-II)
- World Health Organisation disability assessment schedule (WHODAS) 2.0 (17 years and over) or
- PEDI-CAT (16 years and under)
How can someone with Autism apply for access to the NDIS?
You can call 1800 800 110 to make an Access Request or you can ask for a form to be sent to you.
If you need help filling in the form or making the call, you can contact your Local Area Coordinator, Early Childhood Early Intervention partner or your contact your local NDIA office. Find your local office here.
When can an access request be made?
A person can make an access request at any time.
A decision that a person does not meet the access criteria at one point in time does not prevent a person from making a further access request.
However, a person is not able to make a further access request when the NDIA's decision to refuse an earlier access request is in the process of being reviewed internally or externally (section 19(2)).
What support will I receive with NDIS funding for Autism?
Depending on your individualised plan, the NDIS will provide you with a variety of support opportunities. These supports will be based on your goals or the goals you have for your child. It will cover the support you or your child needs to meet these goals.
This could include support with your therapies, technologies, equipment to help with your daily activities or modifications to your home if needed.
Tips for success in accessing the NDIS
- Know the level of Autism Spectrum Disorder in accordance with the DSM-5 (level 1, 2 or 3). You will need an assessment and any supporting documentation that is less than 2 years old.
- Note how the level of ASD corresponds with the NDIS eligibility lists (A, B, C, D or E)
- Understand Functional Capacity and insist that your allied health and medical specialists use the categories of communication, social interaction, mobility, learning, self-management and self-care to describe the impact of autism on everyday living.