The National Disability Insurance Scheme (NDIS) is a vital support system for Australians living with disabilities. To ensure that the NDIS remains financially sustainable, and the supports provided remain relevant and appropriate, the NDIS is in the process of introducing eligibility reassessments.
This process is crucial for maintaining the integrity and effectiveness of the NDIS. Eligibility reassessments will focus on cohorts where the functional impact of the disability for which they entered the NDIS is variable. The focus of the eligibility reassessments is likely to have a disproportionate impact on participants who have diagnoses of ASD level 2, Global Developmental Delay, or those Psychosocial disability types with episodic or variable functional impact.
What is an NDIS Eligibility Reassessment?
An eligibility reassessment is a review process initiated by the NDIS to determine if a participant still meets the criteria necessary to remain an NDIS participant and continue to receive support through the NDIS.
This can occur if there is evidence suggesting that a participant may no longer meet one or more of the eligibility requirements, including residency, disability, or early intervention criteria.
When and Why Are Reassessments Conducted?
Eligibility reassessments will be triggered by various factors, including significant changes in a participant’s condition or circumstances, the NDIS and DSS redefining NDIS eligibility requirements through legislation changes including the introduction of an “Impairment Notice” from January 2025 which lists the impairment(s) the participant met the disability and/or early intervention requirements for.
The NDIS may also initiate an eligibility reassessment if there is new evidence indicating that the participant’s needs have changed, or as people transition out of Early Intervention and “graduate from the NDIS”.
Australia is the only country with a disability support model that is individualised, based on insurance principles and focused on necessary supports that are value for money. This approach is designed to facilitate evidence-based capacity building at key life stages, reduce socialisation isolation and improve economic participation outcomes for those with severe and profound disability related functional impacts. The objective of eligibility reassessments are to ensure that vital supports provided to those with severe and profound disability related functional impact align with the participant’s current situation and needs, while maintaining the financial viability of the NDIS and providing value for money to the taxpayer.
The Reassessment Process (we note that this may be subject to change).
- Notification: The NDIS inform the participant about the eligibility reassessment through their preferred contact method, such as phone or email. A formal letter is also sent to Participants detailing the eligibility reassessment process.
- Evidence Submission: Participants are given the opportunity to provide evidence that they still meet the eligibility requirements. This can include medical reports, therapy assessments, and recommendations from healthcare professionals. Generally speaking, 28 days will be given for this evidence to be supplied. An extension can be requested with evidence supporting the need for additional time.
- Review and Decision: The NDIS reviews the submitted evidence and decides whether the participant continues to meet the eligibility criteria. If the participant is still eligible, they will remain an NDIS Participant and continue to receive support. If not, their status as a participant is likely to be revoked.
- Outcome Communication: The participant will be informed of the reassessment outcome. If they are no longer eligible, they will receive guidance on the next steps and any available support options.
The Reassessment Process (we note that this may be subject to change).
The eligibility reassessment process is already causing a lot of stress and concern within the disability community. For those with the highest level of support need that is directly related to the functional impact of their disability (eg ASD 3 and CP GMFCS 5) maintaining eligibility should not be an issue.
For those who experience a functional impact but don’t have a severe or profound functional impact, the NDIS is likely to undertake eligibility reassessments when the evidence that has been provided to the NDIS does not clearly articulate their disability related support needs in a way that meets the legislative requirements. For some participants, the diagnosis which initially gained entry to the NDIS will no longer meet the eligibility requirements.
Delegates are under significant organisational pressure to reduce or maintain plan sizes when participants still meet eligibility requirements. The changes in the legislation now define an “NDIS Support”. This will have a flow on effect resulting in significant changes in funded supports for many NDIS participants as their plans previously included funding for what are now “Not NDIS Supports”. NDIS eligibility reassessments are a critical component of maintaining the financial sustainability of the NDIS, ensuring that continued support is provided to those with the most severe and profound disability related support needs.
Disclaimer: PlanHELP pride ourselves on being thought leaders in the NDIS space. PlanHELP does not speak on behalf of the NDIS, and often our message is quite diBerent from the NDIS message. Our track record for staying a couple of steps ahead is consistent. If you want to be told everything is all positive, or ignore the changes until they directly impact you, your family or your business these are not the articles for you. We suggest you stick with Facebook and other social media as your source of information. If your goal is to be two steps ahead and you treat the NDIS as your professional hobby, PlanHELP can provide a unique perspective that will assist you to look at the NDIS diBerently. planHELP assist decision makers through training and consultancy to minimise the impact changes within the NDIS have on you, your family or business. PlanHELPs key consultants have spent tens of thousands of hours gaining expertise of the NDIS to support families and businesses on their NDIS journey and have a track record second to none. Read our articles then pay attention to what we, and others, are saying and decide for yourself which companies and professionals are able to keep you well informed of the changes that are rapidly occurring within the NDIS.