NDIS access requirements (eligibility) in plain language

Eligibility for the National Disability Insurance Scheme depends on a person’s age, residency status and disability.  To access the NDIS you must satisfy the following 3 conditions:

  1. be aged under 65 years AND
  2. live in Australia and are an Australian citizen or hold a permanent visa or a Protected Special Category visa AND
  3. have a permanent impairment that significantly affects your ability to take part in everyday activities or have a developmental delay.

The first two criteria are straightforward.  The third point requires further explanation.  The NDIA has provided guidelines to clarify the access arrangements in relation to point 3, the disability requirements.

The easiest way to look at the requirements relating to disability is firstly by age and then by hearing loss.

  1. Children and young people aged 0-25 years

Access is streamlined for people in this age group in recognition of the evidence that shows that early intervention supports up to age 26 is critical for people with hearing impairment as the developing brain requires consistent and quality sound input and other support over that period to develop normally and ameliorate the risk of lifelong disability.

For this age group the evidence from an audiologist that shows…

  • auditory neuropathy or hearing loss equal to or greater than 25 decibels in either ear at 2 or more adjacent frequencies, which is likely to be permanent or long term; and
  • the hearing loss necessitates the use of personal amplification

…should be sufficient to satisfy the access requirements without the need for further assessment.

But what if a person has no auditory nerves?  For participants under 25 years who have a permanent hearing impairment the NDIS operational guidelines states: “The hearing loss of the person necessitates the use of personal amplification.”  It’s confusing but the NDIA said that it does not mean the child has to wear personal amplification.  So, if a child has no auditory nerve and cannot wear a hearing device they will still meet the access criteria.

  1. People aged 26 – 65 years

The level of evidence required to support an access request for people in this age group varies according to the degree of hearing loss.

  1. The NDIA has developed a list of conditions which are designed to streamline the access process. A person with a permanent hearing impairment of greater than 90 decibels in the better ear (pure tone average of 500Hz, 1000Hz, 2000Hz and 4000Hz) is eligible to join the NDIS without the need to prove that their disability has substantially reduced their functional capacity.  It is accepted that this degree of hearing loss will have a significant impact on the person’s functional capacity.

For people with hearing loss less than 90 decibels, the NDIA has given further guidance on what information is required of the applicant:-

  • People with a permanent hearing impairment of 65 decibels or greater in the better ear must provide evidence that the disability results in substantially reduced functional capacity to undertake communication, social interaction, learning or self-management activities.
  • Hearing impairments of less than 65 decibels in the better ear in conjunction with other permanent impairments (which meet the NDIS access requirements for example vision or cognitive impairments), or where there is evidence of significantly poorer than expected speech detection and discrimination outcomes, may also be considered to result in substantially reduced functional capacity to undertake relevant activities. People in these circumstances may also be eligible to join the NDIS.

Providing good evidence will help the NDIA make the right decision about your eligibility for the NDIS.  The evidence should demonstrate the functional impact of your hearing impairment on different areas of your life.  It could relate to the communication challenges you experience in relation to your employment, education and training, social participation, independence or health and well-being.  Your audiologist may be required to provide the evidence to support your NDIS Access Request, so you need to ensure your audiologist fully understands how your hearing loss is impacting on your daily life.