Eligibility and medical conditions FAQ

FAQs GPs and other health professionals ask about eligibility and medical conditions.

A person may satisfy the NDIS access requirements regardless of whether their impairment came about through birth, disease, injury or accident.

To be eligible for NDIS funding, the disease or medical condition must cause permanent impairment (physical, intellectual, cognitive, neurological, visual, hearing or psychosocial), resulting in significant disability.

For example, stroke leading to hemiparesis (the resulting physical impairment substantially reduces mobility) or severe emphysema causing irreversible lung damage (chronic dyspnoea substantially reduces mobility, self-care and participation in community life).

People diagnosed with List A medical conditions are likely to meet the disability requirements because these conditions, by their very nature, are considered to cause permanent impairment and disability resulting in substantially reduced functional capacity.

If your patient has one of these conditions, you only need to provide evidence that they have the condition, and that it has been diagnosed and assessed as per any criteria outlined in List A (e.g. cerebral palsy assessed as Level 3, 4 or 5 on the Gross Motor Function Classification System – GMFCS).

You do not have to provide further information about its functional impact unless specifically requested.

People diagnosed with List B medical conditions are considered to have a permanent impairment.

However, as the severity of the impairment is variable, they will need to demonstrate that as a result of their impairment:

they have substantially reduced functional capacity or psychosocial functioning;
their capacity for social or economic participation is affected; and
they are likely to require support under the NDIS for the duration of their lifetime.

The NDIS will not provide funding or supports for time-limited (non-ongoing) conditions.

For example, reduced mobility due to an acute injury such as a lower limb fracture will not meet the NDIS disability requirement, as the condition is likely to resolve.

The NDIS will also not provide funding or supports for chronic health conditions that are not related to a person's disability. In this regard, it is important to differentiate treatment and care of chronic health conditions and associated comorbidities from disability.

For example, the NDIS may fund disability supports for a person who has had a lower limb amputation due to peripheral artery disease in the setting of diabetes (physical impairment resulting in disability secondary to a health condition), as long as they meet all of the access requirements.

However, the NDIS will not fund medication or medical care relating to the treatment of diabetes or peripheral artery disease.

Psychosocial disability may arise from mental health conditions.

While not everyone who has a mental health condition will experience psychosocial disability, those that do can experience severe effects and social disadvantage.

People with a significant disability that is likely to be permanent may qualify for NDIS support.

For detailed guidance on mental health and the NDIS, please see the Mental health and the NDIS page.