A parent’s guide to NDIS eligibility reassessments for 7-9 year olds
The NDIS is currently exiting a record number of children off the program who have been accessing support for developmental delay or disabilities that the NDIA do not recognise as permanent impairments. (Even though in many cases they are.)
Every week, over 1,200 families receive reassessment letters, forcing them to prove their child’s lifelong disability still exists—within impossible timeframes. More than 6,000 children under nine have already lost access to the NDIS in the last financial year, despite documented needs.
If your child has turned 7 and you are accessing the Early Childhood Approach for developmental delay please be prepared that you will be contacted by the NDIA for a reassessment of eligibility.
NDIS Eligibility Reassessment
Key points
- If your child is accessing the NDIS’s Early Childhood Approach for developmental delay and has turned 7, you need to prepare for a reassessment of their eligibility. This reassessment could result in your child exiting the NDIS.
- After being notified of the reassessment, you have 90 days to provide evidence demonstrating your child meets the NDIS eligibility requirements. Gathering evidence, particularly from specialists, can take a significant amount of time and may be costly.
- The NDIA will assess eligibility based on residence requirements, disability requirements (impairment, permanence, functional capacity), and/or early intervention requirements.
- The NDIA will not take into account that your child is on a waitlist for an autism assessment, even if you provide evidence of this.
- If your child is no longer eligible, they will exit the NDIS.
- If you disagree with the NDIA’s decision you can request an internal review of the decision within 90 days.
The concerns we have
Too many families are having their children removed from the scheme when they do meet the eligiblity requirements simply because they do not have a diagnosis that is listed by the NDIA e.g. autism spectrum disorder level 2 or 3.
This goes against the intent of the NDIS to be focused on functional impacts rather than diagnosis.
It also goes against the NDIS Review principles which states that: “Changes to access and budget setting processes for children and young people should only be implemented once widespread foundational supports are in place.”.
Eligibility Reassessment Process
This describes the process that you will be part of if your child has turned 7 and you are accessing the NDIA’s Early Childhood Approach for developmental delay.
If your child is not on the developmental delay pathway and has been accepted to the NDIS with a primary disability recorded, then this does not apply to you.
If you have recently received a diagnosis of a permanent disability that is listed by the NDIS then make sure this has been updated to your primary disability or you may be subjected to a reassessment or incorrectly advised that your child is no longer eligible for the NDIS.
Notification of Eligibility Reassessment
Prepare Evidence
Review of Evidence
Outcome Advised
Exit or continue on the NDIS
Step One: Notification of Eligibility Reassessment
Step One: You will receive an SMS that someone from the NDIA will phone you, usually in the next 10 minutes or an hour. The NDIA representative will call and tell you that your child’s eligibility will be reassessed. You’ll receive a letter confirming the reassessment and told what is required.
Things to know:
🚽You’ll likely not want to do anything or go to the toilet just in case they call in that minute.
🎣I know a lot of families have been concerned about verifying that the message is in fact from the NDIS and not a phishing situation. I assume that if you have any concerns that you can ask to contact the NDIA through their 1800 number.
❓If you have multiple queries in with the NDIA or children with support plans, the message will not give you any indication as to which enquiry or child you are about to be called about.
❌ If you miss the call, they should call you back, usually the following day.
❌The letter will be general and not very helpful in specifying what evidence they actually want.
📄 If you do not receive a letter, please follow up and make sure you receive one.
Step Two: Provide Evidence
Step Two: You have 90 days to produce evidence that your child meets eligibility requirements for the NDIS. You will be asked to email this evidence to the NDIA.
Criteria | |
|---|---|
Age | Aged under 65 years when access request made |
Residence | An Australian resident holding
citizenship, a permanent visa or protected SCV |
Disability | To meet the disability requirements the NDIA must be satisfied that all five criteria have been met:
|
(a) Impairments: a disability attributable to one or more intellectual,
cognitive, neurological, sensory or physical impairments or an impairment
attributable to a psychosocial disability | |
(b) Permanence: the impairments are, or are likely to be, permanent. | |
(c) Functional impact: substantially reduced functional capacity, or
psychosocial function, to undertake communication, social interaction, learning, mobility, self-care and/or self-management. | |
(d) Social and economic participation: affects capacity for social or economic participation. | |
(e) On lifetime NDIS support: likely to require the lifetime support of the NDIS. |
Things to know:
📅 Until early February families were requested to provide evidence within 28 days The NDIA have backtracked on this now as their legislation always stated that families must have 90 days.
📄Ninety days is still not a lot of time. It can take a LOT longer than that to get into any specialists you may wish to get updated evidence from.
💵 It’s good to be prepared and have used or allocated funding towards securing the evidence of permanent disability and functional impact.
What evidence do I need to provide?
Agggghhhh, the million dollar question! There’s a lot of discussion and advice on this at the moment and it’s almost impossible to get a straight answer from the NDIA.
The NDIA does not give you a lot of information in their first request for evidence – only it seems when they deny you access. It’s hugely frustrating because it adds to stress and often expense for families who need to then source recent reports, letters etc.
It can be very emotional and exhausting to need to prepare documents like Carer’s Impact statements. It would be nice to know definitively if they are even considered at ALL because often it feels like no one has even read the reports you submit.
Functional Capacity Assessment
📄A Functional Capacity Assessment completed by an Occupational Therapist can be very helpful. These reports take a considerable amount of time and dollars. Expect at least $2,000-$3,000 and 10-15 hours of work by an Occupational Therapist.
🍽️ Evidence reliability: evidence from parents or reports that refer to ‘mum noted / dad states’ which is essentially saying ‘mum told us that child is unable to use a knife and fork’ which potentially is unreliable evidence / hearsay. It would be more helpful if therapists can specify what they have personally witnessed and observed firsthand or what has been determined through assessment tools.
🔍 You can find out more about Functional Capacity Assessments and local providers with availability here >> Functional Capacity Assessments
Step Three: NDIA considers evidence
Step Three: The NDIA will consider the evidence against the NDIA’s eligibility requirements.
Things to know:
To continue to be eligible for the NDIS you will need to meet the residence requirements and the requirements for disability, early intervention, or both.
These requirements are listed further down >> How Do the NDIA reassess eligibility?
Step Four: NDIA advises you of the outcome
Step Four: The NDIA will contact you with their Eligibility Reassessment decision. You will receive an SMS notification about the call and then a phone call. You will receive written confirmation explaining the decision.
Things to know:
📅 If your child is determined to be no longer eligible for the NDIS they will:
- leave the NDIS
- will no longer be an NDIS participant
- will no longer have an NDIS plan
- can continue to access the NDIS portal for 180 days. After this you will no longer be able to access the portal for this child
- can use community and other government services instead of NDIS supports.
❌ This is happening even though the NDIS has said there is no doubt that many of these children require intensive support and will continue to require intensive support.
⚽ But the NDIA says that in many cases this is the job of the health system and the health system is run by the state government and you need to get help from them.
❌ In most cases “community and other government services” supports either don’t currently exist, are not sufficient, at capacity or have extensive waitlists for supports that are unlikely to be sufficient and you will become a football between various State and Federal departments.
Waiting for an autism assessment?
The NDIA will not take this into account even if you provide evidence that you are on a waitlist for a public assessment, which currently can take up to four years in Western Australia – especially if your child is older than six years and not prioritised by Child Development Services.
The NDIA says it does not want to continue funding your child while they are on a waitlist in case your child doesn’t meet the criteria when assessed. But, if in the future you do receive an autism diagnosis in the future you can reapply for access. Which is nuts as it’s taking a long time for new families who are applying for access to get set up with a plan, some families have reported they are still waiting at six months … so that could be a long time without supports.
It’s also likely occurring at a time when the child needs even more support as the academic and social expectations at school grow much higher between 7 to 9 years.
The lack of equity for families who cannot afford the approx $3,000 PER CHILD for an autism assessment really, really bothers my sense of social fairness🤯🤯🤯
It’s ridiculous I know and we are failing families who can’t afford a private assessment. If you can afford a private autism assessment and this is an option for your family, you can find providers with availability here >> Autism Assessments
What if my child is no longer eligible for the NDIS?
If the NDIA determine that your child is no longer eligible for the NDIS your child will:
- leave the NDIS
- will no longer be an NDIS participant
- will no longer have an NDIS plan
You:
- can continue to access the NDIS portal for 180 days. After this time you will no longer be able to access the portal
- need to pay all of your service providers within 90 days if you are self-managed
- can use community and other government services instead of NDIS supports.
What if I disagree with the decision?
Internal Review
If you disagree with the NDIA’s decision, you can request an internal review of a decision within three months of receiving notice of this decision.
When asking for an internal review you should explain why you think the decision made is incorrect. The staff member who completes the internal review will be someone different to the original decision maker and will not have been involved in the earlier decision. They may want to talk to you as part of this process.
If you would like to request an internal review of a decision, you can either:
• Send a letter to:
National Disability Insurance Agency
GPO Box 700
Canberra ACT 2601
• Visit an NDIS office
• Call 1800 800 110
• Send an email to enquiries@ndis.gov.au
Contact your Federal and State Members
Please write to your Federal Member of Parliament and ask them to make representation to the NDIA on your behalf.
Please also write to your State Member of Parliament. They will likely tell you that it’s not their responsibility as it’s a Federal program. But, the NDIA is directing families to access “community supports” e.g. State-government Health and Education services which are either at capacity or don’t exist.
Sign the petition
ADHD Mums has a petition you can also sign to highlight this issue: https://www.change.org/p/the-ndis-cuts-are-failing-our-kids-demand-a-stop-now?
What if I disagree with the outcome of the internal review?
Administrative Rview Tribunal (ART)
If you request an internal review and aren’t happy with the decision the Agency makes at that time, you can apply for an external review by the Administrative Review Tribunal (ART). Visit the ART website (art.gov.au). You can also call the ART on 1800 228 333. If you do request a review of this decision, you can’t apply for the NDIS again until a decision is made by the Administrative Review Tribunal.
The NDIS website (ndis.gov.au) provides more information about review of decisions. Search for Our Guidelines and select the link to Reviewing our Decisions to read more.
Who can help?
This can be a very overwhelming process for parents who are already stretched supporting children with developmental delay or disability. Here are some options of people and organisations who may be able to help.
Kiind (formerly Kalparrin) is free to join for parents of children with developmental delay and disability with free one-to-one peer navigation sessions, along with connection to other families and information, tools and resources that will help you a LOT!
Services available:
- Pathway planning with peer navigators by phone or video call
- Parent support groups
- Parent Facebook group
- Parent coaching
Cost: free to members, free to join
The Inclusive Movement is located in Karratha but can provide free support to families across Western Australia.
Services available:
- Assisting with the process, explaining the process and terminology
- Filling out forms
- Helping to gather reports from school and therapy providers to present to the NDIS
- Connecting you with service providers in your community
Cost: free thanks to government funding
Rippleability
RippleAbility provide a paediatric specific service to support parents, carers and participants to navigate through complex systems to secure essential services for children with specific needs.
Services available:
- Access and optimise NDIS supports
- Find essential community and health service
- Overcome service barriers and roadblocks
- Transition smoothly through education and care systems
- Communicate confidently with providers and support teams
- Support coordination (fees applicable)
- Telehealth psychological support for parents and carers (fees applicable with Medicare / private health rebates available)
Cost: Services provided are highly subsidised and based on circumstances. Enquire online, phone 0431 287 807 or email info@rippleability.org
Common Ground Disability support families of children aged 0-14 years around Australia to navigate the NDIS. Anna came recommended by another parent and I found her to be extremely knowledgeable in the NDIS space. She will give you straight answers to your questions and is generous with sharing templates and resources. She also has really helpful content if you subscribe to her Substack blog.
Cost: $161 for 60 minutes of 1:1 Zoom support (you can book up to 3 hours at a time) plus follow up email with a summary of the session with purpose built templates, links and resources.
Other packages are available with full details, costs and how to book available at: https://commongrounddisability.com/ndis-support-packages/
You can find your closest local area coordinator, early childhood partner or NDIS office on the NDIS website. Go to ndis.gov.au, select Contact, then under Offices and contacts in your area you can search your area.
How do the NDIA reassess eligibility?
Residence requirements
The NDIA use the information they have on file and any new evidence you have provided to assess your child’s eligibility. To continue to be eligible for the NDIS you will need to meet the residence requirements and the requirements for disability, early intervention, or both.
To be eligible for the NDIS, you must meet both residence requirements which means:
• you must live in Australia
• you must be an Australian citizen, or the holder of a permanent visa or protected Special Category Visa (SCV).
You’re not eligible for the NDIS if the available evidence doesn’t show you meet these requirements.
Disability requirements
Is your disability caused by an impairment?
To be eligible for the NDIS, you need to have a disability caused by an impairment, or combination of impairments. These impairments may be intellectual, cognitive, neurological, sensory or physical, which reduce your ability to perform day-to-day activities.
This includes impairments related to psychosocial disability.
Is the impairment likely to be permanent?
To be eligible for the NDIS, the NDIA need evidence that your child will likely have an impairment for their lifetime.
Even when their condition or diagnosis is permanent, they’ll check if their impairment is permanent too. For example, your child won’t be eligible if theirimpairment is temporary.
Generally, the NDIA will consider whether their impairment is likely to be permanent after all available and appropriate treatment options have been pursued.
You’re not eligible for the NDIS if the evidence we have indicates your impairment is not likely to be permanent.
Does your impairment substantially reduce your functional capacity?
To be eligible for the NDIS, you need to have a permanent impairment, or combination of permanent impairments, that substantially reduces your capacity to complete everyday activities in one of the following areas:
• communicating
• socialising
• learning
• mobility, or moving around
• self-care
• self-management, if older than 6.
This means you usually need disability-specific supports to participate in or complete the above tasks because of a permanent impairment.
You’re not eligible for the NDIS under the disability requirements if available evidence doesn’t show you usually need disability-specific supports because of a permanent impairment.
Does your permanent impairment affect your social, work or study life?
To be eligible for the NDIS, you must have a permanent impairment which affects your ability to study, or participate in social activities or work, if relevant.
You’re not eligible if available evidence doesn’t show that you are affected in one or more areas because of a permanent impairment.
Will you likely need NDIS supports for your lifetime?
To be eligible for the NDIS, you must be likely to need NDIS supports for your lifetime.
You’re not eligible for the NDIS if available evidence doesn’t show you’re likely to need NDIS supports for your lifetime. For example, your support needs may be best met by other government and community services.
Early intervention requirements
Do you have an impairment that is likely to be permanent?
If a child younger than 6 doesn’t have a permanent impairment, they may be eligible for the NDIS if they have a developmental delay.
To be eligible for the NDIS, a child’s developmental delay needs to meet all the following criteria:
• it must be due to mental and/or physical impairments
• it must substantially reduce their functional capacity for self-care, receptive and expressive language, cognitive development, or motor development – relative to age
• the child needs specialist services from more than one type of professional for longer than 12 months.
A child younger than 6 isn’t eligible for the NDIS if available evidence doesn’t show they meet these requirements.
Even when a child has a confirmed developmental delay, once they’re aged 6 or over, they must have a permanent impairment to be eligible or continue to be eligible for the NDIS.
Will early intervention benefit you so you need less disability support in the future?
We consider whether early intervention supports are likely to reduce your future disability support needs. This may be based on factors such as:
• how long you’ve had your impairment or developmental delay
• how your impairment or developmental delay might change over time
the treatments of supports you’ve already received
• any recommended treatments and their expected outcomes
• any recent or impending significant changes to your impairment or developmental delay.
You’re not eligible for the NDIS if the evidence we have:
• includes recommended supports that aren’t capacity building in nature, and are therefore not likely to reduce future support needs
• doesn’t include specific NDIS support recommendations and their expected outcomes. Early intervention must be likely to reduce future support needs
• includes recommended supports, but doesn’t indicate that these supports are related to a permanent impairment. Or for children younger than 6 years old, a developmental delay.
Will early intervention help your functional capacity or informal supports?
We consider whether early intervention supports are likely to:
• improve your capacity to move around, communicate, socialise, learn, look after yourself or organise your life
• prevent your functional capacity from getting worse
• improve your functional capacity
• support your informal supports, which includes building their skills to help you.
You’re not eligible for the NDIS if the evidence we have doesn’t indicate that early intervention supports are likely to improve your functional capacity, or support your informal supports in the ways listed above.
Will the early intervention supports you need be NDIS supports?
The early intervention support that would likely benefit you must be NDIS supports. NDIS supports are the services, items and equipment that can be funded by the NDIS.
They may only be needed for a short time. We need to understand what outcomes have been achieved from the supports we fund. This is so we can determine if you still need NDIS support.
References
November 2024, NDIS, Outcome of eligibility reassessment
