We’ll look at all relevant information against the eligibility requirements to decide if you’re still eligible for the NDIS. We’ll do this after:
- we let you know we’re reassessing your eligibility, and what specific eligibility requirements we’re looking at
- we let you know what information we need to make our decision. We’ll only ask you to provide this specific information or report if we can’t reasonably get it in a different way.
- you’ve had a reasonable opportunity to give us the information we asked for
- we look at the information you give us.
The person who reassesses your eligibility and decides if you’re still eligible will be one of our staff. They will be different from the people who first decided that you’re eligible, and the people who approved your plans.
They will also be someone who doesn’t have a personal interest in whether you’re a participant or know you, other than through the NDIS.
If there’s information and evidence that shows us you’re still eligible, you’ll remain a participant. You can keep using your NDIS supports.
You may have been eligible under the early intervention requirements but give us evidence that shows you now meet the disability requirements. If so, we’ll change our records to show you now meet the disability requirements. This means we won’t revoke your status as a participant, and you will remain an NDIS participant.
When can you be revoked as a participant?
After we have assessed your eligibility, there are some situations where you can be revoked as a participant, this includes where you have not provided the information we need. This means you won’t be a participant anymore and you’ll leave the NDIS.
We won’t make a decision to revoke your status as a participant if it was reasonable for you not to have provided the information in the agreed timeframe. We’ll consider:
- the timeframe we gave you
- the timeframe since we were last given relevant information about your eligibility
- if you or someone representing you has not complied with our requests before
- if there were things outside your control which meant you couldn’t get the information to give it to us on time
- any other information that may be relevant.
We’ll contact you by your preferred contact method to explain our decision. We’ll also send you a letter with our decision and our reasons, and the date your participant status will be revoked. This date will usually be 28 days from the date the eligibility reassessment decision was made.
Revoking - when you’ve had an opportunity to respond
If we check your eligibility, and evidence suggests that you may no longer meet the eligibility requirements, we will start an eligibility reassessment. We’ll let you know and give you the opportunity to provide us with more evidence about your NDIS eligibility. You’ll have an opportunity to respond in 28 days with the necessary information or request an extension of time to obtain the evidence. We will look at the evidence you provide us. If, based on the evidence we believe you’re not eligible, we will revoke your status as a participant.
Example
Johan is 7 years old. When he was 3, we decided he was eligible under the early intervention requirements for developmental delay. Marita is Johan’s mother and child representative. We haven’t completed a check in or plan reassessment in two years. This is because Marita won’t respond to us.
Marita self-manages Johan’s plan and can see the NDIS funding in Johan’s plan is being utilised. Because Johan is now older than 6 his eligibility needs to be reassessed. To remain a NDIS participant after he turns 6, we need to have evidence that Johan has an impairment that’s likely to be permanent, and he meets the requirements for disability, early intervention, or both.
We send Marita a letter. The letter explains that based on the information we have Johan may no longer meet the eligibility requirements. If Marita thinks Johan is still eligible for the NDIS, they need to provide us with evidence.
The evidence needs to show that Johan meets the requirements for disability, early intervention, or both. Marita is asked to respond within 28 days from the date of the letter. We try to contact Marita using her preferred contact details several times. We don’t hear back within the 28 days. Marita hasn’t asked for more time to provide the evidence we need.
We make the decision based on the evidence already available and decide to revoke Johan’s status as a participant. We send Marita a letter explaining we have revoked Johan’s status as a participant. This means Johan will no longer be eligible and will leave the NDIS.
Revoking - when we’ve asked for specific information or a report
When we ask you for specific information or a report within 90 days, we will consider whether the information or report was sent to us on time, or within an agreed timeframe. If you don’t send us any information within 90 days, or within an agreed timeframe, we will revoke your access to the Scheme.
We will also look at whether the information is in an approved format and an appropriately qualified person completed the assessment or examination.
If you send us the information or report on time and in the correct format, we will use it to decide:
- if we think you’re still eligible
- if we need more information to make a decision.
What if you don’t agree with our decision?
If you don’t agree with our decision to revoke your status as an NDIS participant, you should talk to us. Your planner, local area coordinator or early childhood partner can help explain our decision, answer any questions and explore next steps.
You can also ask for an internal review of our decision to revoke your status as a participant. This means one of our staff, who wasn’t involved in the original decision, will decide if we made the correct decision.
You’ll need to ask for an internal review within 3 months after we tell you in writing that we revoked your status as a participant. You can ask us to stop our internal review at any time.
If you don’t agree with the internal review decision, you can then ask for an external review. This means the Administrative Appeals Tribunal will decide if we made the right decision.
If we decide you’re not eligible, you can apply again, unless you have requested a review of that decision and are waiting for a decision to be made
Learn more about internal and external reviews.
What if you become a participant again because of an internal or external review?
If an internal or external reviewer decides you’re eligible for the NDIS, you’ll become a participant again. You’ll become a participant again from the date you stopped being a participant.
This means we’ll identify the plan you had when you stopped being a participant and put that plan back in place. This plan will continue until we reassess your next plan.
In some situations, you can claim the cost of the NDIS supports you purchased during the period your participant status was revoked. This is the period between the day:
- you stopped being a NDIS participant
- you became a participant again because of the internal or external review decision.
You can only claim funding for NDIS supports purchased when you stopped being an NDIS participant if:
- they were in your plan – the plan that was in place when we revoked your status as a participant
- there is enough funding remaining in that plan
- you have proof of buying and using the supports, such as a receipt
- you claim them within 60 days after you become a participant again.
If your NDIS supports are self-managed or plan-managed, you or your plan manager can claim the funding for NDIS supports as usual. If your NDIS supports are agency-managed, contact us so we can help you claim the funding for NDIS supports.
Learn more about ways to manage your funding .
Example
Charlie is a participant and was eligible for the NDIS under the early intervention requirements.
On 1 July, we decide Charlie isn’t eligible for the NDIS anymore and revoke their status as a participant. We have information that shows Charlie no longer meets requirements for disability or early intervention. Once Charlie’s status as a participant ends they can no longer use their NDIS supports.
Charlie asks for an internal review of this decision. They also give us new evidence from their doctor and specialists about their impairments, functional capacity and support needs.
On 1 September, the internal reviewer decides to set aside the decision to revoke Charlie from the NDIS. This means Charlie is eligible for the NDIS and becomes a participant again.
We treat Charlie as if they were a participant the whole time. This means we put back the plan that existed when their status as a participant was revoked. Charlie’s reinstated plan will remain until it’s replaced by a new plan at their next plan reassessment.
Charlie kept using their supports in July and August after their participant status had been revoked. Charlie paid for these supports with their own money and kept the receipts. Charlie can’t claim every support but can claim NDIS supports that were in the NDIS plan before their participant status was revoked.
Charlie self-manages their funding, so they claim the amount they paid for NDIS supports included in their plan on the my place portal .