Those three important words: reasonable and necessary

Since its inception, the National Disability Insurance Scheme (NDIS) has provided funding for people with disability who qualify for a plan.

The Scheme pays for a broad range of supports and services across different areas – like home and living, assistive technology, and social, economic and community participation. But before you can access them, you first need to make sure they’re right for you, and then you need to show how the supports you’re asking for meet the National Disability Insurance Agency’s (NDIA) reasonable and necessary criteria.

So, what’s reasonable and necessary? Well, here’s what the Agency’s website has to say.

“All NDIS supports need to meet each of the reasonable and necessary criteria before we can fund them in your plan. For example, supports need to relate to your disability support needs, be value for money, and effective and beneficial.”

It’s vital you know and understand the reasonable and necessary criteria because, along with the NDIS support lists, it offers guidance about how you can and can’t use your NDIS funding and what the Agency will and won’t pay for.

Want to know more? Here’s a breakdown.

Reasonable and necessary criteria explained

#1. Is the support related to your disability?

The NDIA doesn’t fund everyday expenses – things all of us might want or need, but which aren’t required for, or related to, disability.

Put simply, there must be a direct link between your disability (the impairment that made you eligible for the Scheme) and the supports you want to access.

Since 1 January 2025, the NDIA’s been telling all new participants in the Scheme what impairment/s made them eligible – information that’s communicated via a Notice of Impairments. Soon, every participant will receive that information.

Our article explains what a Notice of Impairments is and how it impacts your NDIS eligibility and funding.

#2. Will the support help you work towards the goals in your plan?

The NDIA needs to be satisfied that a funded support will help you pursue the goals, objectives and aspirations set out in your NDIS plan.

For example, if your goal is to live independently, the Agency may fund home modifications that address your disability support needs, but it won’t fund expenses that aren’t related to your disability – like rent or utilities.

It’s also worth remembering you can set any goals you like, but the NDIA isn’t obliged to fund them all.

#3. Will the support help you undertake activities to facilitate social and economic participation?

You need to be able to show that the support will help reduce disability-related barriers that prevent you from participating in social and economic activities, such as playing sport, meeting up with friends, volunteering, or working.

#4. Does the support represent value for money?

The NDIA will consider the costs and benefits of different support options and take a long term view on how they’ll benefit you.

For example, a home modification might reduce your need for other funded supports, so if the Agency is considering paying for one, it will take your whole package of supports into account when deciding what’s reasonable and necessary and best value for money.

#5. Will the support be, or is it likely to be, effective and beneficial, having regard to current good practice?

This is where the NDIA will consider if other people with similar disability support needs to you are successfully using the support you’ve asked for.

It might mean you don’t always need an expert report before accessing supports, especially if there’s evidence of other NDIS participants benefitting from them.

#6. Will funding the support take account of what it is reasonable to expect families, carers, informal networks, and the community to provide?

The Agency looks at what’s reasonable to expect of your informal supports – people like family members, carers, friends, neighbours, and community groups. The thinking is that if you want to widen your social and community networks, it makes more sense for the people in your life to help you do that, rather than a paid support.

The NDIA will also look at whether the capacity of your informal supports is decreasing – for example, if your parents are ageing or finding it harder to provide support.

#7. Is the support an NDIS support?

NDIS supports are the services, items, and equipment that can be funded by the Scheme.
The NDIA will only fund a support if it’s deemed an NDIS support for everyone or if it’s a support for a specific group of people you’re a part of (e.g. people with a specific disability).

The Agency won’t fund things that everyone in the community is eligible for, like healthcare, education, justice, housing and more.

If you’d like to know more about the NDIA’s reasonable and necessary criteria, the Agency explains it on this page on the NDIS website. You can also check out these ‘Would we fund it?’ guides.