Autism and the NDIS: Understanding Eligibility

Within the past few years, the way that autism is identified in Australia has changed. Though being diagnosed with Autism Spectrum Disorder (ASD) may bring relief and open up new opportunities of assistance, it may also be confusing, at least in regards to the participation in the NDIS. At Support Network, we are ready to assist you in understanding how autism and the NDIS system work and what you could do.

What Does an Autism Diagnosis Mean Today?

Instead of diagnosing a single disorder as autism, today professionals speak about Autism Spectrum Disorder and divide it into three possible levels:

• Level 1: Support Required
• Level 2: Needs Large Support
• Level 3: Very Substantial Support Required

The levels provide an understanding of the type of support that an autistic individual may require and assist in making decisions concerning therapy, interventions and schemes to which an autistic individual may be eligible, such as the NDIS. Health professionals like speech pathologists, psychologists and paediatricians usually assess this as a part of the process of assessment.

NDIS Eligibility and Autism: How Does It Work?

In order to get into the NDIS, you will have to satisfy three main legal requirements:

• Age: The applicant should be less than 65 years old.
• Residency: You should be an Australian citizen, a permanent resident or a Protected Special Category Visa holder.
• Disability or Early Intervention Requirements: In this area, assessments of autism come in.

Now, regarding the third point, here is where the NDIS eligibility lists can be used.

The NDIS Eligibility Lists Explained

NDIS applies five different lists (A-E) in assisting in establishing the availability of a person according to disability requirements of the scheme. Such lists are aimed at simplifying the application process outlining conditions which either automatically qualify candidates or necessitate further supporting documents.

List A – Conditions That Usually Qualify Automatically

This is in situations where the disability is severe and permanent and the disability is not vague. In the case of autistics, this usually involves:

• Autism Spectrum Disorder that is at Level 2 or 3

These cases do not require additional evaluations to the diagnosis.

List B – Conditions That Need More Evidence

This list entails conditions whose effects are permanent although they may have different impact on people. Individuals who can claim protection under this segment must present proof on the impact of their condition in everyday life. In the case of autism:

• Asperger syndrome
• Atypical autism
• Childhood autism
• Pervasive developmental disorders not otherwise specified (PD-NOS)

Applicants who expectedly have Level 1 diagnosis tend to be within this category and will be required to exhibit diminished ability in general functioning.

List C – State-Based Programs

Such a list contains some of the state-based disability programs. Provided that you are a client in one of these programs, you might automatically qualify to NDIS. The complete list is available on the NDIS website or you can talk to your local support team to find the answers how and what to do.

List D – Early Intervention (Under Age 7)

This list might suit you in the case of your child being less than seven years of age. There are no additional assessments required in order to gain support using early intervention routes.

List E – NSW-Based Qualifying Programs

This is so in the case of New South Wales residents who have attended some of the government-run programs of support like:

• Better Start for Children with Disability
• Assistance to Autistic children

Why Can Autism and NDIS Eligibility Be Confusing?

The problem is that the manifestation of autism in the real world is complicated. A person may possess traits of various levels of severity in the various domains of functioning such as communication, behaviour or social skills. E.g. a person may do Level 1 needs in communication and Level 2 in behaviour.

Due to this difference, Level 2 and Level 3 diagnosis are more likely to create automatic eligibility to NDIS. However, in the case of Level 1 there is need to show more evidence on the level of effect on day to day life.

What Extra Information Is Needed for Level 1 Autism?

In case a person is diagnosed with ASD Level 1, he or she will be required to show that his disability affects his functional capacity in one or more of the following aspects:

• Communication
• Mobility
• Social interaction
• Learning
• Self-care
• Self-management

In order to reinforce this, reports of qualified professionals are in need. The NDIS accepts the assessment offered by:

• Psychologists
• Speech Therapists
• Occupational Therapists
• One of the members of a multidisciplinary team

These assessments ought to be clear in detailing the impact of autism on day to day living with the above mentioned functional categories.

Starting the NDIS Application Process

Starting NDIS can be a daunting experience, but from the beginning to the end, there is all the necessary help.

• Access Request can be called in by calling 1800 800 110, or alternatively, can be requested a form to be completed.
• To assist you with the form, or the process, please contact your:
  • Local Area Coordinator (LAC)
  • Early Childhood Early Intervention (ECEI) partner
  • Closest NDIA location

In the event that your child is within the ages of 0 to 6 years, he or she will receive help using the ECEI pathway, which targets younger children with developmental delays or disability. Feel free to study more about this pathway on the NDIS website or talking to an ECEI partner.

Key Advice Before You Apply

Here are some of the few things that can make the whole process run smoothly even before making use of NDIS:

• Learn ASD Diagnosis Level: make sure it is documented based on the DSM-5 level (level 1, level 2 or level 3).
• Correctly Itemize Under Diagnosis: The right list that corresponds to your conditions is one among the eligibility lists (A to E).

Evaluate Functional Capacity: Collaborate with your health care providers to specify the influences of autism on the day to day life in key areas such as communication, mobility, learning and self-care.

Need Additional Support?

Support Network is here to guide you through the process. While we don’t make diagnoses or handle NDIS decisions, we can connect you with the right professionals, provide information, and help you navigate your support journey with confidence.

If you’re also looking for independent support workers, We have an online platform that connects families and individuals with local workers who can help with everyday care and support needs.