What does reasonable and necessary mean in the NDIS?

Reasonable and necessary is the test in Section 34 of the NDIS Act that determines what supports are funded. Supports must be related to your disability, not the responsibility of other systems, likely to be effective, represent value for money, and account for informal supports and other government programs.

How do I prove an NDIS support is reasonable and necessary?

Provide professional reports from doctors, specialists, and therapists detailing your disability impact and why specific supports are needed. Include functional assessments, evidence of trial results, and clear explanations linking each support to your plan goals.

What happens if the NDIS says my support is not reasonable and necessary?

Request written reasons for the rejection, then provide additional evidence to address any gaps. You can request a plan variation, apply for internal review within 3 months, or appeal to the Administrative Appeals Tribunal if you believe the decision was incorrect.

Does the NDIS fund the cheapest option only?

No. Value for money does not mean cheapest. Sometimes higher-cost supports represent better value because they achieve significantly better outcomes. For example, a $50,000 home modification enabling you to stay home may be better value than $250,000 per year in residential care costs.

Can two people with the same disability get different NDIS funding?

Yes. Reasonable and necessary is assessed individually based on functional impact, informal supports, and goals. Two people with the same diagnosis may have very different support needs. One might need SIL while the other lives independently with minimal supports.

What Are Reasonable and Necessary NDIS Supports?

“Reasonable and necessary” is the fundamental test determining what supports the NDIS funds in your plan. Understanding these criteria helps you request appropriate supports and challenge rejected funding.

Key Points

Reasonable and necessary criteria appear in Section 34 of the NDIS Act and must be met for supports to be funded
Supports must relate to your disability (not general life expenses unrelated to disability impact)
NDIS does not fund supports that are other systems’ responsibilities (health, education, justice, housing)
Value for money is assessed by comparing support cost to expected benefits
Informal supports from family and community are considered when determining reasonable and necessary
Most funding disputes center on differing interpretations of reasonable and necessary
Clear evidence from health professionals strengthens reasonable and necessary justifications

The Six Reasonable and Necessary Criteria

Section 34 of the NDIS Act lists six criteria. Supports must meet all six to be funded.

The support must be related to your disability and help you pursue goals related to life areas such as:

Employment and learning
Social and community participation
Daily living activities
Health and wellbeing
Home and living arrangements
Relationships

Examples:

Funded: Wheelchair because mobility disability prevents walking (related to disability)
Not funded: Gym membership for general fitness unrelated to disability impact
Funded: Psychology for anxiety related to autism (disability-related mental health support)
Not funded: Relationship counseling unrelated to disability

2. Not Responsibility of Other Service Systems

NDIS should not duplicate health, education, justice, or housing system responsibilities.

Health system responsibilities:

GP visits and acute medical treatment
Hospital care and surgery
Prescription medications
Ongoing chronic disease management unrelated to disability

Education system responsibilities:

School curriculum delivery
Standard classroom resources
Teacher salaries and mainstream education delivery

Justice system responsibilities:

Legal representation
Corrections and rehabilitation for offending
Court-mandated programs

Housing system responsibilities:

Providing affordable housing stock
Public housing rental subsidies
Standard housing maintenance (roof repairs, plumbing for non-accessibility issues)

NDIS can fund disability-specific components that help you access these systems. For example:

Support worker to attend medical appointments if disability prevents independent attendance
Communication device to participate in education
Specialist behavior support following court-mandated programs
Home modifications for accessibility (but not general housing maintenance)

3. Likely to Be Effective and Beneficial

The support should reasonably be expected to benefit you and work toward your goals. NDIA considers:

Evidence the support type works for people with similar disabilities
Whether you have tried the support before with positive results
Practitioner recommendations
International research and best practice

Examples:

Funded: Evidence-based therapy with proven effectiveness (such as occupational therapy for motor skills)
Questionable: Experimental therapies without research evidence
Funded: Assistive technology demonstrated to increase independence
Not funded: Very expensive technology with marginal benefit over cheaper alternatives

4. Value for Money

The support must represent good value relative to the benefits it provides. NDIA compares:

Cost of the support vs expected outcomes
Whether cheaper alternatives could achieve similar results
Costs to NDIS if support is not provided (might higher upfront costs prevent more expensive crisis supports later?)

Value for money does not mean “cheapest option.” Sometimes higher-cost supports represent better value because they achieve significantly better outcomes.

Examples:

Good value: $50,000 home modification enabling you to stay home vs $250,000/year residential care costs
Poor value: $80,000 vehicle modification when $15,000 transport funding achieves same access
Good value: $30,000 intensive early intervention preventing need for $100,000+ ongoing annual supports

5. Consider What Is Reasonable for NDIS to Fund

Supports should align with community expectations about government disability program responsibilities. This criterion is subjective and evolving.

NDIA considers:

Whether the support is a normal part of family or household costs unrelated to disability
Whether the support goes beyond disability-related needs
Community standards and expectations

Examples:

Funded: Specialized diet prescribed for disability-related medical condition (beyond normal food costs)
Not funded: General healthy food (normal household expense)
Funded: Assistive technology for communication
Not funded: Latest model smartphone for general use
Funded: Support worker for community participation when disability prevents independent participation
Not funded: Support worker as companion when you have capacity to participate independently or with informal supports

6. Account for Informal Supports and Other Government Programs

NDIS should not replace informal supports naturally available to you or duplicate other government program funding.

Informal supports include unpaid help from:

Family members
Friends and neighbors
Community groups and volunteers
General community services open to everyone

NDIS can fund formal supports when:

Informal supports are not available (no family or friends able to help)
Disability-specific needs exceed what informal supports can reasonably provide
Informal supports are at capacity (carer burnout risk)
Informal supporters need training or respite to continue supporting

Other government programs NDIS must consider:

Medicare and public health services
Public education supports
Public transport and concessions
State/territory disability services
Housing assistance programs
Family support payments

How NDIA Applies Criteria

In planning meetings and plan reviews, planners assess each requested support against the six criteria.

Evidence Requirements

Strong evidence makes reasonable and necessary justifications easier. Provide:

Professional reports: From doctors, specialists, therapists, psychologists detailing disability impact and why specific supports are needed
Functional assessments: Occupational therapy assessments showing how disability reduces functional capacity
Trial results: Evidence you tried the support and it worked, or that similar interventions succeeded
Goal alignment: Clear explanation how the support helps achieve specific plan goals

Burden of Proof

You must demonstrate supports are reasonable and necessary. NDIA does not need to prove supports are unreasonable or unnecessary. This means:

Provide detailed evidence with access requests and plan reviews
Explain clearly how supports relate to disability
Justify costs if supports are expensive
Show cheaper alternatives are inadequate if requesting premium options

When NDIA Rejects Supports

Common rejection reasons:

Insufficient evidence: No professional reports or assessments justifying the support
Not disability-related: Support addresses general life needs unrelated to disability impact
Health or education responsibility: Support should be funded by other government system
Informal supports available: Family or community can reasonably provide this support
Poor value: Support cost is disproportionate to expected benefit
Not likely to be effective: No evidence the support type works for your disability

If supports are rejected, request written reasons. This allows you to address gaps (provide more evidence, explain why health system cannot fund, etc.) and request internal review if needed.