Skip to main content

A fair, consistent and empowering NDIS experience

We have heard overwhelming evidence from participants and families that the participant pathway needs a wholesale overhaul. We agree.

This is required across the three key areas of the participant pathway:

  1. Accessing the NDIS
  2. Budget setting
  3. Implementing a budget

A different approach is also needed for those who require early intervention support.

Back to top

The current approach to accessing the scheme is inequitable and isn’t always targeted to those people with disability who require the most support

There are two pathways to access set out in the National Disability Insurance Scheme Act 2013 (NDIS Act): section 24 (disability requirements) and section 25 (early intervention). However, the introduction of diagnostic lists, known as access lists, by the National Disability Insurance Agency (NDIA) has meant there is an additional pathway. Through this pathway, some applicants experience very different evidence requirements to prove eligibility compared to those not covered by an access list. The key distinction between the different access lists is that List A and List D effectively provide automatic access based on diagnosis, while List B provides streamlined access based on diagnosis.

Figure 3: High-level overview of the different access pathways
Section 24 (s24)Section 25 (s25)Access Lists
Disability Requirements
Access under section 24 for people with disability with permanent Impairment, substantially reduced functional capacity and lifetime support needs
Early Intervention
Access under section 25 for people with disability with permanent impairment who are likely to benefit from early intervention supports and are best supported by the NDIS

Automatic access:

List A
Conditions likely to meet section 24 eligibility

List D
Conditions for those under 7 likely to meet section 25 eligibility

Streamlined access:

List B
Conditions likely to meet permanent impairment criteria for section 24 or section 25

The lists have played an important role during the initial roll-out of the NDIS. They helped the NDIA manage its resourcing limitations and shortened wait times by helping decisions move more quickly. They have also continued to provide benefits after transition, such as ensuring more timely decisions and support for applicants with conditions that are clearly permanent and lead to substantially reduced functional capacity.

At the same time, the access lists have led to unintended consequences. Now that we are at full scheme, access lists are creating inequity between people with a condition on a list, and people with a similar level of need but with a different condition not on a list. This is driving access to be based on diagnosis, rather than functional impairment and need.

We have heard some applicants with conditions not included on an access list are not getting the supports they need because the access process is too complex or it is too difficult to gather the required evidence.

I have been unable to access the NDIS because the application process is so horrible to engage with... I am suffering and there is nowhere I can turn for help. The NDIS needs to serve all disabled people, not just those who can work the system.

- Person with disability 77

We have heard that the current Access Request Form is complex, particularly for those who are unfamiliar with the NDIS, its processes and jargon. Many questions are structured in such a way that interpretation is difficult for participants and treating professionals alike. There are additional barriers for participants from culturally and linguistically diverse backgrounds, those with lower levels of literacy, intellectual disability or limited informal supports due to its lack of accessibility.

Many people with disability who haven’t applied or had an unsuccessful application have indicated this is because “getting supporting documentation for the access request was too challenging”.78 Decisions on access are too often being influenced by the amount or type of supporting evidence provided to the NDIA, rather than need. This favours better resourced applicants, those better equipped to navigate a complex process and those with strong advocates to navigate on their behalf.

Current forms are cumbersome and inefficiently designed, with an emphasis on the requirement for the use of correct phrasing to obtain approvals as opposed to a narrative that conveys what supports the patient requires

- Royal Australian College of General Practitioners 79

My child's specialists have to rewrite medical documents in 'NDIS speak' for the NDIA to accept them. These specialists are not trained in completing NDIS Access Request Forms... and nor should they have to be… I want help from specialists who are excellent in their field, not because they are adept in NDIS semantics.

- Carer 80
Back to top

The way participants receive NDIS funding is adversarial and leads to inequitable funding outcomes

The concept of ‘reasonable and necessary supports’ is a key driver of the current challenges with planning. Under the NDIS Act, supports must meet the criteria of being reasonable and necessary in order to be funded. However, this is a legally technical, complex, broad, discretionary concept that has irresolvable tensions.81

Reasonable and necessary was deliberately kept broadly defined in the legislation to enable the scheme to flexibly respond to individual need and circumstance. This flexibility of response has come at a price. There is a lack of clarity and confusion and what the scheme should fund is contested. This means reasonable and necessary can play out in inconsistent ways and creates an expectation gap for participants between what supports are wanted and what the NDIS can sustainably deliver.82

The current approach of requiring every individual support to be considered reasonable and necessary has further compounded the problem. The confusion and contested nature of what is reasonable and necessary can therefore play out for every single support item for a participant. Planners end up in the middle of the expectation gap between what supports participants request and what the NDIS can fund. Planners rely on external evidence from treating professionals and providers to try and bridge this gap. This means supports are approved (or not) on the basis of the sufficiency of evidence and/or the ability of the individual or their family and supporters to advocate. This means funding is not always directly linked to need.

Feeling like it depends on the planner and their personality rather than solid processes and procedures as to how my plan might turn out

- Participant 83

I always feel like I'm taking a bit of a wild stab in the dark when it comes to funding therapies… I guess it's hard to write procedures that are good for everyone, especially given the different ways that the same disability might affect different people.

- NDIA Planner, National Delivery 84

NDIS is not consistent with decisions... saying [something] is NOT approved but yet others get it (that need it less)... only because of who made the decision on the day at NDIA

- Participant 85

Many participants have told us that their experience of the planning process is stressful and traumatising. Participants and families point to the adversarial nature of the process, which often pits them against a planner who they feel is trying to limit their budget, rather than working to find the best way to support them. Planning meetings are described as negotiations or worse. Planners take a deficit-based approach to assessing need, and participants must present themselves in the worst light to better justify each support they are seeking.

In my experience, planners have not wanted to know how my disability affects my everyday life.

- Participant 86

The next round (of so called planning) we face will be the ninth time in the past year that our daughter's deficits and difficult circumstances will have been trawled through in detail in order to seek reasonable and necessary supports for her.

- Carer 87
Back to top

Participants receive inconsistent and insufficient support to implement their plan

We have heard that participants are not being sufficiently supported to understand or implement their plan. While a significant amount of scheme resourcing is consumed managing the planning process described above, limited support is available to participants once a plan has been approved.

The plans provided to participants are inflexible and difficult to understand. They feature complex language and confusing support categories. The rules guiding how funding can be spent are opaque and confusing. We have heard participants find it difficult to understand exactly how their funds can be spent. Some are afraid to breach complex guidelines. This creates inequities between those who have learnt to navigate the scheme and those who require more support to make the most of their funding.

Itemised plans allocated to a multiplicity of support categories can disempower and frustrate participants. The NDIS was designed on an assumption of participants acting like empowered consumers in a marketplace. Instead, they face arbitrary barriers that disempower them and limit decisions on how to spend funding.

You’re allocated a certain amount of money in your plan, but it’s too compartmentalised, it’s inflexible. You might use up all the money in one portion, while you still have the money in a different section that can’t cross over. You can’t use the money for just what needs to be done. It’s got to be done within a specific range.

- Participant 88

These issues are compounded by the culture of fear and mistrust that exists around plan reviews. Itemised plans work best when there are regular reviews to check they are still appropriate and can change if needed. They are not suited to long periods without being revisited. The NDIA currently conducts frequent plan reviews for participants to ensure items remain appropriate and are meeting need. However, many participants are fearful of plan reviews and will allow plans to roll-over to avoid having to go through a traumatising review process.

I am too terrified to have to face a plan review and have to justify my needs when I see what has happened to other people… [I] can’t leave my house as no one can transport my electric wheelchair and I am too scared to… request a vehicle modification as scared about having a plan review and having my current funding cut.

- Participant 89
Back to top

There is no specific approach for those who would benefit from and require early intervention

The original vision for early intervention in the NDIS has not been realised. The intent was to fund cost-effective interventions aimed at reducing the impacts of long-term disability by improving outcomes for people with disability and reducing long term costs. The Productivity Commission linked eligibility for early intervention to consideration of whether the intervention would be safe, significantly improve outcomes and be cost effective.90

We have heard that access to the scheme through section 25 (early intervention) has been operationalised without a rigorous link between eligibility and the three key criteria: existence of evidence that early intervention for the participant would be safe, significantly improve outcomes and be cost effective. Early intervention participants appear to be predominately receiving the same approach as those who enter through section 24 (disability requirements).

There are also few mechanisms available to support participants to understand the purpose of early intervention, especially for adults. Participants are given little help to understand what good outcomes from early intervention might look like, what sorts of supports would best help achieve this, or how to adapt when a chosen approach is not working.

The early intervention pathway for adults is unclear and not well understood by planners and assessors. Many people do not know that they can access it, how it can support them, what supports are available and what evidence is needed to meet the criteria.

- MS Australia 91
Back to top