What Conditions Qualify for the NDIS in 2025–26

Reading time: 10 minutes  |  Updated: April 2026  |  Written by: TEAH Allied Health Team

One of the most common questions families ask when they first encounter the NDIS is simple: does my condition – or my child’s condition – actually qualify? The answer is not always straightforward, because the NDIS does not fund diagnoses. It funds the functional impact of those diagnoses on daily life.

Understanding this distinction is the starting point for any NDIS access journey. A diagnosis opens the door to an application; it does not guarantee approval. What matters to the NDIA is whether the condition creates significant, permanent limitations in how the person functions across daily activities. This guide explains which conditions typically qualify, which ones fall into grey zones, which ones are explicitly excluded, and what evidence makes the difference.

How the NDIA Decides – Diagnosis vs Functional Impact

The NDIS operates under the National Disability Insurance Scheme Act 2013, which sets out two pathways to eligibility:

1. The disability requirements pathway — the person has a disability caused by a permanent impairment that significantly reduces their functional capacity in one or more of six domains: mobility, communication, social interaction, learning, self-care, or self-management.
2. The early intervention requirements pathway — providing early intervention support would be likely to reduce the future impact of an early developmental delay or disability (primarily relevant to children under 9).

Notice that neither pathway mentions specific diagnoses. The NDIA assesses functional capacity — what a person can and cannot do in daily life — not the label attached to their condition. This has two important implications:

• Two people with the same diagnosis may receive very different NDIS outcomes depending on how their condition affects their functioning.
• A person may qualify for the NDIS with a condition that is not on any published “eligible” list, if they can demonstrate significant functional impairment.

Conditions That Clearly Qualify for the NDIS

Certain conditions are so consistently associated with permanent, significant functional impairment that NDIS eligibility is routinely granted when the diagnosis is confirmed and supported by functional evidence. These include the conditions on the NDIA’s List A (see below), plus many others with well-established disability profiles.

Conditions in the Grey Zone – It Depends on Severity

Many conditions sit in a grey zone where NDIS eligibility is not automatic — it depends on the severity of functional impairment in the individual case. These are conditions where some people clearly qualify while others with the same diagnosis do not, because the condition’s impact on daily functioning varies significantly between individuals.

Conditions That Generally Do Not Qualify

Some conditions are specifically excluded from NDIS eligibility – either by legislation or by NDIA policy. Understanding these exclusions prevents wasted time, money, and emotional energy on an application that is unlikely to succeed.

Conditions the NDIS does not fund

• Age-related conditions in people over 65 – the NDIS is for people under 65 at first access; older Australians with age-related disability are directed to the aged care system
• Conditions that are temporary or likely to resolve – broken limbs, post-surgical recovery, most acute mental health episodes; the NDIS requires permanent or likely-permanent impairment
• Conditions managed within the health system – the NDIS funds disability supports, not health treatment; ongoing medical management (medication, surgery, standard GP or specialist care) is a Medicare responsibility
• General mental health conditions responding well to treatment – the NDIS is not intended to fund clinical mental health treatment; it funds the ongoing functional disability arising from a mental health condition where that disability is persistent despite treatment
• Workplace-related injuries – where compensation is available through workers’ compensation schemes, the NDIA generally expects those schemes to fund reasonable supports first
• Conditions arising from social disadvantage alone – poverty, housing instability, or social isolation without an underlying disability do not qualify

List A and List B – The NDIA’s Diagnostic Lists Explained

The NDIA uses two internal diagnostic lists – List A and List B – to streamline eligibility decisions. Understanding these lists helps you anticipate how the NDIA will approach your application.

List A – Conditions where disability is assumed

List A contains conditions where the NDIA accepts that a disability meeting the eligibility criteria is present without requiring additional evidence of functional impairment. The diagnosis alone, confirmed by an appropriate specialist, is sufficient to establish the disability requirement. Examples of List A conditions include:

• Blindness (bilateral, best corrected)
• Deafness (bilateral profound, not correctable with hearing aids)
• Deafblindness
• Intellectual disability (IQ below 70 confirmed by psychologist)
• Autism Spectrum Disorder (where diagnosed by an appropriate specialist)
• Down syndrome
• Cerebral palsy (most presentations)
• Spinal cord injury (most presentations)
• Acquired brain injury with confirmed permanent impairment

For List A conditions, the primary requirements are a confirmed diagnosis from an appropriate specialist and evidence that the condition is permanent. You do not need to separately prove functional impact – it is assumed from the diagnosis.

List B – Conditions requiring functional evidence

List B conditions are those where the diagnosis does not automatically establish disability eligibility – because the functional impact varies significantly between individuals with the same condition. For List B conditions, functional evidence documenting how the condition affects daily activities is required in addition to the diagnostic confirmation. List B includes conditions such as:

• Multiple sclerosis
• Parkinson’s disease
• Epilepsy
• Schizophrenia and other psychotic disorders
• Bipolar disorder
• PTSD and complex PTSD
• Chronic conditions with variable functional presentation

For List B applications, the OT functional assessment is not just helpful – it is the document that bridges the gap between the diagnosis and the eligibility determination.

Children – Developmental Delay and the Early Childhood Approach

For children under 9, the pathway to NDIS supports is different from the standard eligibility process. The Early Childhood Approach (ECA) allows children with developmental delays or disabilities to access early intervention supports without requiring a formal diagnosis or a standard NDIS access request.

What developmental delays qualify under the ECA?

The ECA is designed to support children who are not yet meeting developmental milestones and for whom early intervention is likely to be beneficial. This includes:

• Speech and language delays
• Motor development delays (fine motor, gross motor, coordination)
• Sensory processing differences affecting participation
• Social and emotional development concerns
• Global developmental delay
• Autism presentations where formal diagnosis is pending

Under the ECA, an Early Childhood partner (funded by the NDIS) conducts an initial assessment and connects the child with appropriate early intervention providers – including occupational therapists – without requiring the family to navigate a full NDIS access request.

When does a child transition to a standard NDIS plan?

Children receiving supports through the ECA may transition to a standard NDIS plan at age 7–9 if their disability is confirmed as permanent and significant. The OT reports and early intervention progress documentation built up during the ECA period form the evidence base for this transition.

Why Functional Evidence Determines Eligibility More Than Diagnosis

This is the insight that most transforms how people approach NDIS applications – particularly for grey-zone conditions. The NDIA’s eligibility assessment is fundamentally about function, not pathology. The most common reason well-founded applications fail is not that the person doesn’t qualify – it is that the submitted evidence describes the condition rather than its functional consequences.

Compare these two descriptions of the same person with MS:

Both describe the same person. The first gives the NDIA nothing to act on. The second – which is what a well-produced OT functional assessment provides – gives the NDIA the standardised, quantified evidence it needs to make and defend a funding decision.

The OT Assessment – Your Most Powerful Eligibility Tool

For conditions outside List A – and sometimes even for List A conditions where the functional impact needs to be established for plan funding purposes – an OT functional assessment is the most influential document in an NDIS application.

A well-structured OT functional assessment for NDIS eligibility purposes will:

• Document functional capacity across all six NDIS domains using standardised, validated tools (WHODAS 2.0, Barthel Index, Vineland-3, ABAS-3, Fatigue Severity Scale, and others as relevant)
• Quantify support needs by task, frequency, and level – not just describe them in general terms
• Describe the permanence of the functional limitations and address whether they are likely to resolve
• Connect the functional findings directly to the underlying disability
• Document the impact on daily life in plain language that a non-clinician can understand and act on

At TEAH, our OT assessments for NDIS access purposes are conducted in the participant’s home — the only way to capture a true picture of real-world functioning rather than best-case clinical performance. Each assessment includes a draft review stage so the participant and their coordinator can check accuracy before the report is finalised.

The cost of an OT functional assessment conducted privately (before NDIS access is approved) typically ranges from $1,200–$2,000 depending on complexity. Once an NDIS plan with Capacity Building — Improved Daily Living is in place, future OT assessments are funded from that budget at the 2025–26 PAPL rate of $193.99 per hour.

Frequently Asked Questions

Summary

NDIS eligibility is determined by functional impact, not diagnosis. Many conditions clearly qualify — including autism, intellectual disability, ABI, cerebral palsy, MS, and spinal cord injury. Others sit in a grey zone where eligibility depends entirely on the severity of functional impairment and the strength of the evidence submitted. The OT functional assessment is the most powerful single document in any NDIS access application, translating clinical diagnosis into the standardised, quantified functional evidence the NDIA needs to act.

Whether your condition is clearly on the list, in the grey zone, or you are supporting a child through the Early Childhood Approach — TEAH’s occupational therapists can conduct the assessment that gives your application its best possible chance.