What Are The Disability Conditions Covered Under NDIS & What Is Not Covered?

disabled patient on a wheelchair in green background

The National Disability Insurance Scheme (NDIS) is a vital program that provides support and funding to over 500,000 Australians with disabilities, with an annual budget exceeding $22 billion. In Australia, approximately 4.4 million people live with a disability, and the NDIS plays a pivotal role in enhancing their lives. It connects individuals with disability to various services and community resources, including access to mainstream community supports facilitated by local councils and funded supports outlined in NDIS plans.

To qualify for NDIS assistance, individuals must meet specific eligibility criteria, including being Australian citizens or residents residing in the country, being under 65 years of age, and requiring support due to a permanent or significant disability.

This article will delve into some of the disability conditions covered by the NDIS and highlight areas that are not covered.

Disability Conditions Covered Under NDIS

The NDIS disability services categorize disabilities into two main lists: List A and List B. While there are also List C and List D, these pertain to different aspects of the NDIS framework.

List A: Conditions Likely to Meet the Requirements

The NDIS Act defines disability in Section 24. Conditions that commonly meet the NDIS requirements include:

  1. Autism: Diagnosed by a qualified medical professional experienced in assessing Pervasive Developmental Disorders, using the current DSM-V diagnostic criteria at Level 2 or 3 severity, indicating substantial or very substantial support.

  2. Genetic Conditions: These conditions consistently result in severe intellectual and physical impairments and include syndromes like Angelman, Coffin-Lowry (in males), and Cri du Chat, among others.

  3. Epidermolysis Bullosa: Severe forms of this skin condition are covered.

  4. Leukodystrophies: Conditions like Canavan disease and Krabbe disease with severe intellectual and physical impairments.

  5. Mucopolysaccharidoses: Specifically, MPS 1-H (Hurler syndrome) and MPS III (San Fillipo syndrome) are covered.

  6. Osteogenesis Imperfecta: Severe forms, such as Type II, with significant fractures and deformities, are included.

  7. Spinal Muscular Atrophies: This covers conditions like Werdnig-Hoffmann disease (SMA Type 1- Infantile form) and Dubowitz disease (SMA Type II – Intermediate form), among others.

  8. Intellectual Disability: Diagnosed and assessed as moderate, severe, or profound according to current DSM criteria.

  9. Permanent Blindness: As diagnosed and assessed by an ophthalmologist, meeting specific visual acuity or visual field criteria.

  10. Permanent Bilateral Hearing Loss: Greater than 90 decibels in the better ear.

  11. Amputation or Congenital Absence of 2 Limbs: This refers to any combination of two legs, two arms, or a leg and an arm.

  12. Spinal Cord or Brain Injury Resulting in Paraplegia, Tetraplegia, or Quadriplegia.

  13. Severe Cerebral Palsy: Rated at level 3 or above on the Gross Motor Function Classification System (GMFCS).

  14. Deafblindness: Confirmed by both an ophthalmologist and audiologist, resulting in permanent and severe to total impairment of visual function and hearing.

  15. Hemiplegia: Severe or total loss of strength and movement in the affected limbs of the body.

  16. Genetic Conditions: Conditions resulting in permanent or severe intellectual or physical disability.

List B: Permanent Conditions That Need More Assessment

Apart from disabilities, some other permanent conditions may require additional assessment and can still receive NDIS funding. These include neurological impairments like Parkinson’s disease or Alzheimer’s dementia, certain types of intellectual disability, speech or hearing impairments, chromosomal abnormalities like Down syndrome, physical disability such as amputation, or a combination of these conditions.

List D: Permanent Disability or Early Interventions

This category covers conditions where functional capacity may vary, necessitating further assessment. For example, children with permanent disabilities like Down Syndrome can be covered under the NDIS. In such cases, parents receive support and assistance through initiatives aimed at helping them care for their children.

How To Become an NDIS Participant

To access NDIS support, individuals must submit an Access Request Form application to the National Disability Insurance Agency (NDIA). The application should include supported evidence, and applicants must meet the eligibility criteria. NDIS funding eligibility applies to people born with or acquiring a disability. To qualify for an NDIS plan, the disability must result in permanent impairment or significant disability, encompassing cognitive, intellectual, physical, visual, hearing, neurological, or psychosocial challenges.

Decisions on funding are typically made by NDIS plan management providers. NDIS funding covers reasonable and necessary supports that help individuals achieve their goals, connect with their community, and support them in leading ordinary lives.

Which Supports Are Not Covered Under NDIS?

While the NDIS offers support for assistive technology, daily transportation assistance, social and community participation, and support for further education and employment goals, it typically does not fund:

  1. Medication.
  2. Diagnosis assessments.
  3. Doctor or hospital visits.
  4. Services or items provided as part of a diagnosis, treatment, or ongoing care of chronic health conditions.
  5. Sub-acute care, including geriatric or end-of-life care.

The NDIS strives to provide support for a wide range of disability conditions. The scheme recognizes that every person’s disability is unique and aims to offer personalized support to enhance their independence, community participation, and overall quality of life. It operates on a person-centered approach, tailoring supports and plans to meet each participant’s individual needs and goals.

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