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Missing In Action: Eligibility Safeguards

Kylie points out where potential participants fall through the gaps in access to the NDIS.

By Dr Kylie Morgan

Updated 18 Apr 202410 Feb 2021

It’s no secret that accessing NDIS is challenging for many people. Those who have not transitioned from a defined program or lists which streamline access have to provide a whole suite of medical information about their condition, including a diagnosis (where possible), previous treatments and evidence that their condition is likely to be permanent. In addition, people are required to provide detailed information about their day-to-day functioning.

The NDIA recently released a consultation paper on the proposed new Access and Eligibility Policy for Independent Assessments (IAs). One of the key justifications they use for implementing IAs is that the Agency needs consistent, high-quality evidence to make equitable decisions regarding access to the Scheme. IAs would theoretically eliminate the need for people to obtain evidence on the impact of their disability on their day-to-day functioning. 

Many people have raised very legitimate concerns about the use of IAs to test eligibility; however, this is not what we will be focusing on today, because – before a person even qualifies for an IA – they need to prove to the NDIA that they have a disability and that it is likely to be permanent (i.e., fully treated and stabilised).

So, even with IAs, there are still some major equity flaws in the system. For me, the whole process still has a huge element of middle-class presumptiveness (OK, so “presumptiveness” is not actually a word, but I like it!). Any person seeking access to the NDIS needs to have maintained specific mainstream supports, including those detailed below.

1. Access to doctor(s) who can provide a diagnosis

This may seem simple, but there is a cohort of people with a disability who have been unable to seek regular medical care for a variety of reasons, including people in unstable housing or living situations and people whose disability impacts their capacity to maintain a relationship with a single doctor or medical clinic. In these circumstances, it is highly unlikely that a person will be able to obtain a letter confirming their diagnosis by randomly dropping into a medical clinic they have not previously attended. This is not to lay blame on the medical professionals; they are just fulfilling their duty of care. 

However, where does that leave people with no established relationships with medical professionals? To further complicate this situation, the NDIA often requests confirmation of the diagnosis or condition from a specialist. When there is no regular GP, specialist letters have often been lost in the ether. Therefore, any new GP supporting a person with an access request needs to chase down the specialist, if indeed the person has even seen one and is able to recall the specialist’s name. 

2. Access to medical history

For the purpose of establishing the permanency of a condition, the NDIA requires people to demonstrate that they have tried all available evidence-based treatments. To provide this evidence, people need to have personally retained a copy of their medical history or have had a consistent relationship with a medical team that has this information. So, even if a person is able to obtain a diagnosis, the level of evidence needed here still requires a relatively long-term relationship with a medical team.

3. Ability to communicate with doctor(s) about what needs to be submitted to NDIA

The reality is that not all doctors (either GPs or specialists) have been trained in providing evidence for NDIS access requests. Therefore, it often up to the person requesting access to inform the doctor about what evidence to include. This requires research and effective communication. I have spent years buried in all things NDIS, so I can communicate the relevant information. However, for people who don’t live and breathe the NDIS, or who speak English as a second language, or who haven’t been able to spend hours on Google working everything out because of their disability, this is probably out of reach. 

My question is, “Where are the safeguards for people unable to gather the required medical information about their disability?” After many years in this space, I have come to realise that they simply don’t exist. But we need an NDIS that provides equity of access to everyone – not just the middle class!

Authors

Dr Kylie Morgan

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