Navigating the NDIS: For Participants and Healthcare Professionals


Published: 11 July 2022

This article is intended to help healthcare professionals and people living with disability understand, access and navigate The National Disability Insurance Scheme (NDIS).

The following topics will be covered:

What is the NDIS?

The National Disability Insurance Scheme (NDIS) is a government-led initiative intended to support Australians who are living with intellectual, physical, sensory, cognitive and/or psychosocial disability (NDIA 2021a).

Supports offered by the NDIS can range from assistance with daily personal activities, to mobility aids and home modifications, to therapeutic supports (NDIA 2021b).

The NDIS is designed to help eliminate barriers to living a fulfilling and productive life for around 500,000 Australians (under the age of 65) living with permanent and significant disability, providing them with the necessary supports required (NDIA 2021a).

This is achieved by connecting people to services in their communities such as doctors, sporting clubs, libraries and schools, as well as supplying information about what support is provided by each state and territory government (Australian Department of Human Services 2019).

Note: The NDIS is not to be confused as a replacement for the Disability Support Pension – this pension still provides income support through Centrelink to people aged 16 to 65 who are unable to work as a result of their disability (NDIA 2020a).

The NDIS does, however, offer additional funding to meet the particular special needs of a person living with disability, such as buying a wheelchair or having assistance at home (Laragy 2016).

NDIS participant wheelchair user
Supports offered by the NDIS can range from assistance with daily personal activities, to mobility aids and home modifications, to therapeutic supports.

Why is the NDIS Essential?

The NDIS was created in response to a 2011 Productivity Commission report on Disability and Care, which found that disability services, as existed in 2011, were:

  • Underfunded
  • Unfair
  • Fragmented
  • Inefficient.

(NDIA 2021c; Productivity Commission 2011)

In response to these findings, the Commission suggested a system of flexible individual funding packages that could be accessed to purchase disability supports (The Conversation 2016) - hence, the implementation of the nationwide NDIS service.

What is the NDIA?

The National Disability Insurance Agency (NDIA) is the independent government organisation that administers the NDIS.

The NDIA makes decisions regarding whether someone is eligible to become an NDIS participant and, if so, how much funding they are entitled to. This is based on the National Disability Insurance Scheme Act 2013 (NDIS Act), which details supports and services the NDIS will fund (NDIA 2021d).

What is Meant by ‘Insurance Scheme’?

The term ‘insurance scheme’, reflects the intention of the NDIS: to take a ‘lifetime approach’, providing support where needed and investing in people with disability early on to improve their outcomes later in life (NDIA 2021e).

What is the NDIS Commission?

The NDIS Quality and Safeguards Commission is an independent agency that was established to regulate the safety and quality of NDIS supports and services. The NDIS Commission aims to ensure that NDIS participants receive supports that afford them choice, control and dignity (NDIS Commission 2018).

Where is the NDIS Available?

The NDIS is available in all Australian states and territories.

What is Funded by the NDIS?

There are 15 types of supports and services funded by the NDIS. These include:

  1. Assistance with daily life
  2. Transport
  3. Consumables
  4. Assistance with social and community participation
  5. Assistive technology
  6. Home modifications
  7. Coordination of supports
  8. Improved living arrangements
  9. Increased social and community participation
  10. Finding and keeping a job
  11. Improved relationships
  12. Improved health and wellbeing
  13. Improved learning
  14. Improved life choices
  15. Improved daily living.

(NDIA 2021f)

Supports and services that cannot be funded by the NDIS include those that:

  • Are unrelated to the participant’s disability
  • Are the same as other supports already being delivered under different funding through the NDIS
  • Include day-to-day living costs unrelated to the participant’s disability support needs
  • Carry a risk of harm to the participant or others
  • Can be more effectively delivered by other systems e.g. health or education.

(NDIA 2021f)

The National Disability Insurance Agency (NDIA) is the independent government organisation that administers the NDIS.

Who is Eligible for the NDIS?

To be eligible for NDIS funding, an individual must:

  • Be between the ages of 7 and 65
  • Be an Australian citizen, permanent resident or Protected Special Category Visa holder
  • Live in Australia
  • Have an intellectual, cognitive, neurological, sensory, physical or psychosocial disability caused by permanent impairment (including ‘episodic and fluctuating’ conditions), and
  • Require supports that the NDIS is able to provide.

(NDIA 2022a, b)

For more information, see the NDIS Eligibility Checklist.

Note: Children aged under the age of seven with developmental delay or disability can access NDIS supports through a separate pathway known as Early Childhood Early Intervention (ECEI) (NDIA 2020b).

Applying for the NDIS

Those who are eligible for NDIS funding (or their carers) must apply by:

  1. Making an access request, either by:
    • Making a verbal access request over the phone by calling 1800 800 110 and providing the necessary information
    • Completing and submitting an Access Request Form
  2. Providing objective evidence of their impairment and its functional impact from a relevant treating professional (e.g. general practitioner).

(NDIA 2021g)

Lodging an Access Request Form

The current Access Request Form requires the participant (with a healthcare professional’s assistance) to address areas such as:

  • Personal and contact information
  • Privacy and consent
  • Information regarding carers and family
  • The participant’s disability and need for supports
  • Evidence of disability
  • The participant’s functional capacity
  • Assistance the participant may need.

(NDIA 2021i)

The NDIS Access Request Form can be downloaded from the NDIS website:

Where to Go for Further Help Applying

The NDIS has partnerships with local community organisations known as Local Area Coordinators (LACs) (Disability Support Guide 2018).

LACs can assist with:

  • Understanding and accessing the NDIS
  • Developing an NDIS support plan
  • Implementing an NDIS support plan
  • Reviewing an NDIS support plan
  • Linking potential participants to the NDIS and supports in their local area.

(NDIA 2020c)

Note that LACs cannot approve an NDIS plan (NDIA 2020c).

Learn more about LACs here:

Creating an NDIS Plan

For healthcare professionals: you may need to assist a patient with creating an NDIS plan. A plan is intended to aid the NDIA in gaining an understanding of a participant’s support needs. The planning process can also involve family, carers and significant others (Summer Foundation 2020).

For participants: Your NDIS plan should outline your short-term and long-term goals - i.e. milestones you want to achieve with support from the NDIS as well as other supports and services. Goals should ideally be SMART (specific, measurable, achievable, realistic and timely) (NDIA 2022c).

Examples of goals include becoming more independent, getting a job, learning new skills, enrolling in an educational course, engaging with their community or improving relationships and making friends (NDIA 2022c).

It’s ideal that the planning process is led by the participant (to the extent they want to) and from there, an individualised plan will be devised.

You may need to assist a patient with creating an NDIS plan.

Considerations for the Plan

An NDIS plan should take into account the participant’s:

  • Aspirations
  • Goals
  • Strengths and abilities.

(Continence Foundation of Australia 2021)

The plan should also consider:

  • The type of supports needed by the participant
  • The amount of funding they receive now
  • Steps that will help them to achieve their goals
  • Current providers they can speak to about their current services.

(Continence Foundation of Australia 2021)

Additional NDIS Responsibilities for the Healthcare Professional

Healthcare professionals are able to carry out the following tasks:

  • Help patients understand how the NDIS works
  • Refer patients to information about who can access the NDIS
  • Provide supporting evidence as part of an Access Request Form
  • Document that the patient has or is likely to have a permanent disability
  • Provide copies of reports or assessments relevant to the diagnosis/condition to describe the extent of the functional impact of the disability.

(NDIA 2020b)

For more information, please see the NDIS’ information for GPs and healthcare professionals, available at:

Providing Evidence of Disability to Support a Patient

The evidence you supply to support an NDIS Access Request must relate to the patient’s primary disability that has the greatest impact on their life. Any additional evidence relating to other disabilities that may affect your patient and the impact they have on their functional capacity will also be accepted (NDIA 2020b).

You will need to provide evidence the patient has, or is likely to have, a permanent disability, including information about:

  • The type of disability
  • The date their disability was diagnosed (if available)
  • How long the disability will last
  • Available treatments (i.e. medications, therapies or surgeries).

(NDIA 2022d)

You will also need to describe the impact of the disability on the patient’s day-to-day function in each of the following areas:

  • Mobility and motor function
  • Communication
  • Social interaction
  • Learning
  • Self-care
  • Ability to self-manage.

(NDIA 2022d)

How to Manage Funding


There are three ways in which NDIS participants can choose to manage their funding:

  1. Self-management: The participant negotiates the supports specified in their confirmed plan, including employing support workers
  2. Plan-managed funding: The participant engages a provider (referred to as a plan manager) to manage their funding
  3. NDIA-managed funding: The NDIA to manages the funding and pay providers on the participant’s behalf.

(NDIA 2021h)

The participant may also choose to use a combination of the above options (NDIA 2021h).

In 2016, it was found that only 7% of participants chose to self-manage their funds, while 35% combined self-management and agency management and 58% were fully agency-managed (Laragy 2016).


As a healthcare professional, your compassion, professionalism and guidance can greatly help to facilitate a patient’s NDIS journey.

As a prospective participant of the scheme, remember that you do not need to navigate the NDIS on your own; there are individuals, communities, agencies and resources readily available to you.

It does not need to be thought of as a daunting process.



educator profile image
Ausmed View profile
Ausmed’s editorial team is committed to providing high-quality, well-researched and reputable education to our users, free of any commercial bias or conflict of interest. All education produced by Ausmed is developed in consultation with healthcare professionals and undergoes a rigorous review process to ensure the relevancy of all healthcare information and updates to changes in practice. If you have identified an issue with the education offered by Ausmed or wish to submit feedback to Ausmed's editorial team, please email with your concerns.