Understanding Reasonable & Necessary Supports
The NDIS funds supports using rules set out in legislation and supporting guidelines. In recent years, there have been changes to NDIS laws that clarify what the NDIS can and cannot fund, including a clearer definition of “NDIS supports.”
The most useful way to understand funding decisions is to separate into two questions:
Is the item/service an “NDIS support” (something the NDIS is allowed to fund)?
If it is an NDIS support, does it meet every “reasonable and necessary” criterion for this participant, in their circumstances?
Both questions matter. A support can be helpful and still not be fundable under the NDIS rules. Below is an explanation of how the reasonable and necessary criteria works and how the NDIA applies them when creating or reviewing plans.
What are “Reasonable and Necessary” Supports?
The NDIS is designed to put people with disability at the centre of decision-making through individual choice and control, while also applying legislated funding criteria. “Reasonable and necessary” supports are the supports funded in a participant’s plan to meet disability support needs, where those supports meet the requirements in NDIS law and rules.
The NDIA explains that, to be considered reasonable and necessary, a support must be related to disability needs, represent value for money, be likely to be effective, and take into account supports available through families, carers, community networks, and other government services.
“NDIS Supports”
NDIS legislation changed that commenced in October 2024 introduced a clearer definition of NDIS supports and clarified some boundaries around what can be funded. NDIA information summarises these changes notes the scheme will only fund NDIS supports for impairments that meet disability and/or early intervention requirements.
The NDIA also publishes support lists (supports that are NDIS supports, supports that are not NDIS supports, and a replacement supports list) to help participants understand what can be claimed.
Examples of supports commonly described as NDIS supports include assistance with personal daily living tasks and community access, therapeutic supports, and personal mobility equipment, provided they meet the funding criteria for the participant and are allowed under the support lists and rules.
The Reasonable and Necessary Criteria
The basis for the reasonable and necessary criteria sits in the NDIS Act (section 34) and related rules and guidance.
When deciding whether a specific support can be included, the NDIA needs to be satisfied that all criteria are met. The criteria described in NDIA resources and the NDIS Act framework include:
1. The support is related to disability support needs
There must be a direct link between the participant’s disability-related support needs and the support being requested. The NDIA commonly uses examples like gym memberships or flights for holidays as supports that are not funded because they are not directly connected to disability support needs and are ordinary living or lifestyle expenses many people may want.
2. The support helps pursue goals in the plan
Supports should help pursue goals, objectives, and aspirations in the plan, but participants do not need a separate, explicitly written goal for every single line item. The NDIA indicates the decision is made by considering the participant’s overall situation and the disability-related barriers to the support addresses.
3. The support helps social and economic participation
This criterion is about whether the support helps a person undertake activities that facilitate participation in social and community life, education, volunteering, and employment-related activities. The NDIA links this to reducing disability-related barriers that prevent participation.
4. The support represents value for money
Value for money is a required consideration in the NDIS Act’s section 34 framework. The NDIA explains that value for money involves considering costs compared to benefits and comparing reasonable alternatives that could achieve the same outcome at a lower cost.
The NDIA also publishes the NDIS Pricing Arrangements and Price Limits (formally called the “Price Guide”) which sets pricing controls to support value for money across the scheme.
In practice, value for money decisions often involve quotes, comparisons between similar products, and considering whether a higher-cost option provides meaningfully different outcomes.
5. The support is likely to be effective and beneficial, having regard to current good practice
The NDIA describes considering whether there is evidence the support is effective for someone with similar disability support needs, and whether it aligns with current good practice. This does not always require an expert report for every support, because the NDIA may rely on established evidence, commonly accepted practice, and the participant’s experience of what has or has not worked.
6. The funding takes account of informal supports and what it is reasonable for others to provide
The NDIA considers what is reasonable to expect families, carers, informal networks, and the community to provide. This can differ for children and adults depending on age, typical community expectations, and risk factors for carers. The NDIA also recognises sustainability and wellbeing of informal supports as part of these considerations.
7. The support must be an “NDIS support” for the participant
Even if a support seems helpful, the NDIA can only fund supports that are within the NDIS support framework (including the updated definition and support lists).
What the NDIS Can’t Fund
The NDIA sets out examples of thing the NDIS cannot fund, including day-to-day living costs such as groceries, rent, or utilities, and other excluded items such as alcohol and illicit drugs.
The NDIA also provides a “Would we fund it” guide with examples that show how planners apply the reasonable and necessary criteria in different situations.
Why a recommendation from a health professional isn’t always funded
Professional recommendations are considered, but they do not overrise the requirement for every support to meet every funding criterion. A common example is when a recommended option is not considered value for money compared with an alternative that can achieve the same outcome.
If a Support is Not Included
If a requested support does not meet the criteria, it cannot be included in the plan. In practice, the NDIA may consider whether a differently described support, or a different support type, may meet the criteria instead, or whether the need should be met through mainstream/community supports.
If a participant wants more detail on plan funding, the NDIA provides information about explaining decisions, and participants can request further detail. For example, they can request a budget breakdown or written reasons, depending on the decision type and context.
Why Funding Can Change
Supports can change over time because functional needs and circumstances change. Because the NDIA reassesses whether a particular support still meets the criteria at that point in time. Circumstances where capacity-building supports may reduce as skills increase, or where needs increase or decrease over time.
Disagreeing with a Funding Decision
Participants can request an internal review of certain NDIA decisions within set timeframes (commonly within three months of receiving the decision, depending on decision type). The NDIA’s guidance on decision-making and reviews sets out available pathways.
Practical Preparation Tips
There are practical steps that often improve clarity during planning and review decisions:
Link each requested support to a disability-related need and the barrier it reduces, not just a diagnosis
Be clear about what outcome the support enables (participation, safety, independence, maintaining function, etc.)
Where cost is high, prepare quotes and explain why an option is needed compared to alternatives
Keep evidence focused on function and daily impact over time, and include relevant professional input where needed
Separate everyday living costs from disability supports early, to reduce confusion in the request
Understanding the reasonable and necessary criteria can help participants plan more effectively and reduce frustration when a requested support is not funded. The NDIA must apply the criteria set out in the NDIS Act and related rules, and must also follow updated laws and support lists that clarify what is and isn’t an NDIS support.
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