Autism Eligibility for NDIS

 

There has been a lot of confusion around the Autism diagnosis and eligibility for the National Disability Insurance Scheme (NDIS). The recent “accidental” change to the operational guidelines by the NDIA was certainly at the centre of this. Where they published information stating that Autism Level 2 would no longer be accepted automatically as eligible for NDIS. This was later retracted by the agency as a “accident” (hmmm weird accident but let’s move on).

Following this retraction by the NDIA, The Australian newspaper then published an article stating there was  “A radical plan to alter the definition of autism” and that the NDIS was working with researches to change the way Autism is categorised in an effort to “restrict access to the $22 billion National Disability Insurance Scheme”. This however seems a little illogical to me. Are the NDIA working alongside researchers who are looking at bring in subtypes toe the Autism spectrum and abolishing the level diagnostic criteria established under DSM V? Highly likely. As a psychologist I can see the advantages to such a change. However, to change how Autism is diagnosed requires a lot of research to support such a change and the DSM V to be republished. The DSM V is published by the American Psychological Association – not too sure Australian policy around the NDIS would be enough to see them completely rewrite a section of this book!

 

It does however seem that NDIS is looking at how to reduce funding requirements and is interested in ensuring eligibility for those on Spectrum is tightened.  The key thing to focus on here however is that the NDIS legislation is VERY CLEAR that eligibility is NOT related to a diagnosis. Eligibility to the scheme IS based on functional impairment related to a form of disability. So, the diagnosis is not important. A diagnosis is helpful to identify there is a disability. However, stating that Autism Level 2 is unlikely to be eligible is not relevant. What is relevant is whether the individual in question has significant functional impairments across the domains identified in the access form to warrant need for reasonable and necessary supports.

I am constantly reminding Support Planners at the NDIA that requesting a diagnosis, an IQ assessment etc is not necessarily in line with their own legislation, and, that what they really want to know is what are the functional impairments caused by the disability. A diagnosis can guide the answer to this question, for example most people on the Spectrum have difficulties of varying degrees in social skills and communication. What the NDIA want to know is what do these difficulties look like and how do they impact the person on a day to day basis.

 

If you or someone you care about has Autism and is seeking eligibility for NDIS, or coming up for a plan review. Remember, whether you are eligible or what supports you receive should not be based on what label you have been given by a professional. By all means take your diagnostic report with you though, it can help. You really need to be talking about your skills or areas you need support or help with because of your disability in the areas of:

  • Mobility
  • Communication
  • Social Interaction
  • Learning
  • Self Care
  • Self Management

If you are refused eligibility because of your diagnosis, then you have the right to have that decision reviewed. I would be citing the NDIS legislation around functional impairment of an individual not a diagnosis as being the means by which your eligibility MUST be measured.

 

 

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