What Are The Disability Conditions Covered Under NDIS & What Is Not Covered?

The NDIS supports over 500,000 Australians and provides over $22 billion in funding annually to people with disability. According to the Australian Network On Disability, about 4.4 million Australians have a disability. NDIS provides individuals with connections to services and information in their communities. Some of these services include access to mainstream community supports. For example, through local councils and funded supports through an NDIS plan.

The NDIS can also offer guidance on what specific government states and territories provide access to support. To receive NDIS funding and assistance, you must pass the eligibility criteria, including being an Australian citizen or resident living in Australia, below 65 years old and needing support due to a permanent or significant disability.

This article will discuss some disability conditions covered under NDIS.

Disability Conditions Covered Under NDIS

The NDIS disability services cover two main disability areas. List A and B. There are also C and D, but these explain different aspects.

List A: The Conditions Likely to Meet the Requirements

Disability is outlined in Section 24 of the NDIS Act.

1. Autism is diagnosed by a psychiatrist, pediatrician, specialist multidisciplinary team or clinical psychologist with experience assessing Pervasive Developmental Disorders. It must be assessed using the current DSM-V diagnostic criteria as being at Level 2 severity and requiring substantial support or in Level 3, which requires very substantial support.
2. Genetic conditions that consistently result in permanent and severe intellectual and physical impairments:

• Angelman syndrome
• Coffin-Lowry syndrome in males
• Cornelia de Lange syndrome
• Cri du Chat syndrome
• Edwards syndrome (Trisomy 18 – full form)
• Epidermolysis Bullosa (severe forms):
  • YR
  • Autosomal recessive dystrophic epidermolysis bullosa
  • Hallopeau-Siemens type
  • Herlitz Junctional Epidermolysis Dystrophica
• Lesch-Nyhan syndrome
• Leigh syndrome
• Leukodystrophies:
  • Alexander disease (infantile and neonatal forms)
  • Canavan disease
  • Krabbe disease (globoid cell leukodystrophy) – Infantile form
  • Pelizaeus-Merzbacher Disease (Connatal form)
• Lysosomal storage disorders resulting in severe intellectual and physical impairments:
  • Gaucher Disease Types 2 and 3
  • Niemann-Pick disease (Types A and C)
  • Pompe disease
  • Sandhoff disease (infantile form)
  • Schindler disease (Type 1)
  • Tay-Sachs disease (infantile form)
• Mucopolysaccharidoses – the following forms:
  • MPS 1-H (Hurler syndrome)
  • MPS III (San Fillipo syndrome)
  • Osteogenesis Imperfecta (severe forms):
  • Type II – with two or more fractures per year and significant deformities severely limiting the ability to perform activities of daily living
• Patau syndrome
• Rett syndrome
• Spinal Muscular Atrophies of the following types:
  • Werdnig-Hoffmann disease (SMA Type 1- Infantile form)
  • Dubowitz disease (SMA Type II – Intermediate form)
  • X-linked spinal muscular atrophy

1. Intellectual disability diagnosed and assessed as moderate, severe or profound by current DSM criteria.
2. Permanent blindness in both eyes as diagnosed and assessed by an ophthalmologist as followers:

• Corrected visual acuity (the extent to which an object can be brought into focus) on the Snellen Scale must be less than or equal to 6/60 in both eyes; or
• Constriction to within 10 degrees or less of the arc of central fixation in the better eye, irrespective of corrected visual acuity (i.e. visual fields are reduced to a measured arc of 10 degrees or less); or
• A combination of visual defects resulting in the same degree of visual impairment as that occurring in the above points. (An optometrist report is not sufficient for NDIS purposes.)

1. Permanent bilateral hearing loss > 90 decibels in the better ear (pure tone average of 500Hz, 1000Hz, 2000Hz and 4000Hz).
2. Amputation, or congenital absence of 2 limbs, could be two legs, two arms, or a leg and an arm. Note: it can’t be a leg, a hand, an arm, or a foot.
3. Spinal cord or brain injury resulting in paraplegia, tetraplegia or quadriplegia.
4. Severe cerebral palsy rated level 3 or above on the Gross Motor Function Classification System (GMFCS)
5. Deafblindness confirmed by an ophthalmologist and audiologist and assessed as resulting in permanent and severe to total impairment of visual function and hearing.
6. Hemiplegia where there is a severe or total loss of strength and movement in the affected limbs of the body.

Genetic conditions could result in permanent or severe intellectual or physical disability such as:

• Cornelia de Lange syndrome,
• Angelman syndrome,
• Cri du Chat syndrome,
• Edwards syndrome (trisomy 18 – full form),
• coffin-Lowry syndrome in males,
• Epidermolysis Bullosa (severe forms),
• Leukodystrophies,
• Lesch-Nyhan syndrome,
• Leigh syndrome,
• Mucopolysaccharidoses – the following forms; MPS III, Osteogenesis Imperfecta, MPS I-H and Type II with two or more fractures per year.
• Hemiplegia refers to a severe or total loss of movement and strength in the affected limbs of the body.

List B: Permanent Conditions that Need More Assessment

Apart from a disability, there are other permanent conditions that might require additional assessment and still be funded by NDIS. They include;

• Neurological impairment like Parkinson’s disease or Alzheimer’s dementia,
• Certain types of intellectual disability,
• Speech or hearing impairments,
• Chromosomal abnormalities like Down syndrome,
• Physical disability such as amputation or,
• A combination of these conditions.

List D: Permanent Disability or Early Interventions

These are conditions for which the functional capacity is variable and further assessment of the functional capacity is required. For instance, children with a permanent disability like Down Syndrome can get covered under the NDIS and receive NDIS disability services. The parents will receive support and assistance through initiatives to help them care for their children.

How To Become an NDIS Participant

Submit an Access Request Form application to NDIA for NDIS support. The application must have supporting evidence, and the participants must meet the eligibility criteria for funding. Eligibility for NDIS funding applies to people who are born with a disability or acquire a disability. To qualify for the NDIS plan, the disability must have caused permanent impairment or significant disability. For instance, cognitive, intellectual, physical, visual, hearing, neurological, or psychosocial problems resulting in a significant disability.

The funding decisions are usually made by NDIS plan management providers. NDIS will fund reasonable and necessary supports to help individuals achieve their goals, connect with their community and to support them to live an ordinary life.

Which Supports Are Not Covered Under NDIS?

The NDIS funds offer support for assistive technology, assistance with daily transportation, social and community participation, and support to help them achieve further education and employment goals. The NDIS will typically not fund support for:

• Medication,
• Diagnosis assessments,
• doctor or hospital visits
• Services or items provided as part of a diagnosis, treatment, or ongoing care of chronic health conditions.
• Sub-acute care, including geriatric or end-of-life care.

The NDIS provides supports to a wide range of disability conditions. The scheme recognises that every person’s disability is unique and thus aims to offer personalised support to enhance their independence, community participation and overall quality of life. Additionally, it’s crucial to note that the NDIS operates on a person-centred approach. It offers supports and plans tailored to meet each participant’s needs and goals.

If you have any questions about NDIS plan management, please contact us at 1800 63 63 77 or email us at info@ndsp.com.au.