Autism and the NDIS: how is eligibility determined?

Community, Disability August 5, 2019

In recent years, the method by which people are diagnosed with Autism has changed. While a diagnosis of Autism Spectrum Disorder (ASD) can be a positive step for families seeking greater understanding and support, for Australians applying for the NDIS, it can create some confusion. We take a look at why, and how an ASD diagnosis is used to determine eligibility for the scheme.

Today, rather than one diagnosis of Autism, individuals with ASD are diagnosed along a spectrum, categorised by severity (at Level 1, 2 or 3) which can provide insight/guidance into the support requirements of an individual with Autism. We recently wrote about this topic on our blog, and what a diagnosis of ASD means for individuals today.

The ASD categories below are used by professionals like speech pathologists, psychologists and paediatricians to determine how much support a family might need.

  • Level 1 – Requires Support
  • Level 2 – Requires Substantial Support
  • Level 3 – Requires Very Substantial Support

How diagnosis of ASD impacts eligibility for the NDIS

Eligibility for the NDIS is, in part, determined by the diagnosis of ASD at Level 1, 2 or 3. If you are applying for support under the NDIS, it is important to understand how these levels correspond with the NDIS eligibility lists.

So, to get back to basics, access to the NDIS is determined by three legal requirements:

  • Age requirements (i.e. be under 65 years of age)
  • Residence requirements (Must be an Australian citizen or meet specific residence requirements.)
  • The applicant must meet disability or early intervention requirements.

What are the NDIS eligibility lists?

The NDIS eligibility lists come in when looking at the third point above; the disability requirements. The eligibility lists (A-E) are provided as guidance via the Operational Guidelines of the scheme. Specifically, the NDIS eligibility lists are used to determine if someone would automatically have access to the NDIS, or if more evidence about functional capacity is required.

The Autism Awareness Australia website features a simplified explanation of what these eligibility levels categorise – we’ve also summarised them below.

List A is a list of conditions and disabilities for which access to the NDIS will be very likely. (i.e. The applicant is likely to meet the disability requirements in section 24 of the NDIS Act.) The purpose of this list is that people with obvious severe and profound impairment will be given access to the scheme without providing much information about functional capacity.For those with Autism, this includes a diagnosis of either Level 2 or Level 3.
List B lists permanent conditions that require more evidence about functional impact, or how the disability impacts daily life, to gain access to the scheme. Typically, these are permanent conditions in which functional capacity is variable.

For those with Autism, this would include:

  • Pervasive developmental disorders not meeting severity criteria in List A or List C
  • Asperger syndrome
  • Atypical autism
  • Childhood autism

List C – refers to a list of defined state-based programs. Clients of these programs would generally be considered to satisfy the disability requirements without further evidence being required. Click on this link to read the full list.

List D – Permanent Impairment/Early Intervention, under 7 years – no further assessment required.

List E – Provides a list of qualifying programs which are provided to residents of New South Wales, and administered by the New South Wales Department of Family and Community Services. Examples include:

  • Better start for Children with Disability
  • Helping Children with Autism

Challenges in understanding how a diagnosis of ASD relates to NDIS eligibility

In an article on the Every Australian Counts website, Katharine Annear, Chair of the Australia and New Zealand Self Advocacy Network explains why there are challenges in applying these NDIS lists in defining the needs of people with Autism.
The support needs of an individual with ASD vary from situation to situation. As such, when a severity rating (or level) is provided at diagnosis, there are different areas that it can apply to; social communication, and restricted interests and repetitive behaviours. That means that an individual can have a combination of levels. With a Level 2 or Level 3 Autism diagnosis, the NDIS provides automatic access with no more assessments required. However, with a Level 1 diagnosis, this is not the case, and additional evidence is required.

What additional evidence may be required for someone with Level 1 ASD to access the NDIS?

Someone with a Level 1 diagnosis will need to provide further evidence of the impact that autism has on their life. The impact would generally relate to reduced functional capacity in one or more of the following areas: Communication, Mobility, Social Interaction, Learning, Self-Care and Self-Management.

For a diagnosis of Autism, the NDIS have stated the following health professionals are appropriate to provide standardised assessments.

  • A member of a multidisciplinary team
  • Psychologist
  • Occupational Therapist
  • Speech Therapist

How do I start the process of applying for the NDIS?

You can call 1800 800 110 to make an Access Request or you can ask for an access form. 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.

If your child is aged 0-6 years, they will access the NDIS via the Early Childhood Early Intervention (ECEI) pathway. To find out how that works, you can read our recent blog here.

Autism Awareness Australia provides the following advice for those starting the process of applying for the NDIS:

  • Know the level of Autism Spectrum Disorder in accordance with the DSM-5 (level 1, 2 or 3)
  • Note how the level of ASD corresponds with the NDIA 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 define the impact of autism on everyday living.

Mable is an online platform where you can connect with independent support workers in your area. Find out how NDIS participants are accessing more hours of support by directly engaging their support workers via the platform.