Key Takeaways
- The NDIS may consider disability-related health supports, while diagnosis, treatment and acute care remain health-system responsibilities
- Clinical, equipment and training supports must be assessed individually against NDIS criteria and supporting evidence
- A health condition alone does not establish NDIS access — the NDIA assesses age, residence and disability requirements, or early intervention requirements where relevant
- Strong clinical evidence is critical for NDIS access and plan reviews
- An independent nurse consultant can bridge the gap between disability and health systems
Living with disability and complex health needs can mean dealing with more than one system. The NDIS and mainstream health system have different responsibilities, and the right question is not simply “who will pay?” but “what support is disability-related, what evidence is relevant, and which system is responsible?”
This information is general. The NDIA considers each participant’s circumstances, goals, evidence and the NDIS support criteria when making funding decisions.
The NDIS and the health system: different responsibilities
Disability-related supports
The NDIS may consider supports that help manage or reduce the day-to-day impact of a disability, where they meet NDIS criteria and are supported by evidence.
Mainstream health supports
Diagnosis, treatment, hospital services, ambulance transport, medicines, child and maternal health services and palliative care remain health-system responsibilities.
Important: a support is not automatically funded because it is clinical. The NDIA assesses whether it is disability-related, meets the NDIS criteria and is supported by appropriate evidence.
Disability-related health supports that may be considered
Depending on individual circumstances, relevant supports can include skilled nursing or therapy, continence-related items, PEG-related items, respiratory care, diabetes management, wound or pressure care, seizure management and training for people who support the participant.
- Clinical information that clearly explains the disability-related functional impact and daily support need
- Assistive technology, equipment, therapy or worker training where it is appropriate to the disability-related need
- Coordination that helps connect disability, mainstream health and community supports with the participant’s consent
Access and evidence
A health diagnosis alone does not establish NDIS access. The NDIA considers age and residence requirements, as well as disability requirements or, where relevant, early intervention requirements. For disability access, evidence needs to show how a permanent impairment significantly affects everyday functioning and why ongoing supports may be needed. Evidence should be recent, specific to you and prepared by an appropriate treating professional. What this means for you: ask your treating professional to describe day-to-day function, the support, aid or modification needed, and how often it is needed. The NDIA considers the full evidence and makes the decision.
When systems overlap
If you are unsure which system is responsible, speak with your doctor or treating health professional first about the health condition. Your my NDIS contact can help you understand the NDIS process; if you have a support coordinator or recovery coach, they may also help connect disability, mainstream health and community supports. What to do next: before information is shared, ask what will be shared, why and with whom, and give consent where it is required.
How CHNSS can help
CHNSS provides independent education and clinical navigation. With your consent, we can help organise relevant clinical information, clarify health and disability responsibilities, and support communication with your providers. CHNSS does not make NDIA funding decisions or replace your treating team.
Trusted Australian Resources
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Frequently Asked Questions
Some disability-related health supports may be considered where they meet NDIS criteria and are supported by evidence. Funding is individual; diagnosis, treatment, hospital services, medicines and other mainstream health responsibilities are not funded by the NDIS.
To apply to the NDIS, you must be aged 0 to 64 and meet the residence and disability or early intervention requirements. Government-subsidised aged-care assessment is generally for people aged 65 or over, with some assessment pathways from age 50. Existing NDIS participants who turn 65 can generally choose NDIS or aged-care supports, but cannot use both systems at the same time; specific residential or home-care transitions can require leaving the NDIS. Discuss your circumstances with My Aged Care and your my NDIS contact before choosing a pathway.
With your consent, CHNSS can help clarify health and disability responsibilities, prepare clinical information, and support communication between your health and disability providers. We do not decide NDIS funding.
Healthcare Disclaimer: This article provides general information only and does not constitute medical advice. Always consult your healthcare provider for advice specific to your situation. CHNSS provides independent nursing consultation and healthcare navigation — not medical diagnosis or treatment.
