NDIS (National Disability Insurance Scheme)

The NDIS is a government-funded scheme that provides support for early intervention services for children diagnosed with a disability. To determine eligibility for funding, your child must first be assessed against the access criteria.

Children under 13 years of age may be eligible for funding to support both assessment and treatment. Children under 15 years may be eligible for treatment funding only if they have a prior diagnosis of Autism Spectrum Disorder (ASD) or Pervasive Developmental Disorder (PDD).

I Think My Child May Have Autism (ASD) or PDD – What Should I Do?

If you suspect your child may have Autism Spectrum Disorder (ASD) or Pervasive Developmental Disorder (PDD), it’s important to understand the criteria for accessing NDIS support.

To be eligible for NDIS funding, your child must meet the following general requirements:

• Permanent Impairment or Condition
  Your child has a condition or impairment that is likely to be permanent (lifelong).
• Substantial Impact on Daily Life
  The condition significantly limits your child’s ability to take part in daily activities or perform tasks without assistance—such as help from others, technology, or assistive equipment.
• Reduced Participation
  The impairment affects your child’s ability to participate socially or economically (e.g. in school, play, or the community).
• Ongoing Need for Support
  Your child is likely to require support from the NDIS over their lifetime.

Early Intervention Eligibility

Your child may also be eligible for early intervention support if:

• The condition is likely to be permanent, and there is evidence that early support will make a meaningful difference.
• The required supports are best provided through the NDIS (rather than another system, such as health or education).
• Your child is under 6 years of age and has a developmental delay that substantially affects their ability in one or more areas, such as:
  • Self-care
  • Receptive and expressive language
  • Cognitive development
  • Motor skills

The government recognises the importance of early intervention and aims to provide support where there is strong evidence it can improve outcomes or slow down further decline in functioning.

NDIS Funding Cannot Be Used For:

• Covering out-of-pocket costs for Medicare-funded services
• Paying for missed or cancelled appointments

Want to Learn More?

Visit the NDIS website at www.ndis.gov.au or call 1800 800 110 to check whether your child meets the access requirements.

Helping Children With Autism (HCWA) – Medicare Funding for Early Intervention

The Helping Children with Autism (HCWA) initiative is a government-funded program that supports children diagnosed with Autism Spectrum Disorder (ASD) or Pervasive Developmental Disorder (PDD) in accessing early intervention services. This support is provided through Medicare rebates for assessment and therapy services delivered by private allied health professionals, including Psychologists, Occupational Therapists, and Speech Pathologists.

What Funding Is Available?

Eligible children can access:

• Up to 4 Medicare-rebated sessions for allied health assessments
• Up to 20 Medicare-rebated therapy sessions for allied health intervention

These sessions are available once only and cannot be claimed again once used.

Age Eligibility Criteria

• Children under 13 years may be eligible for both assessment and therapy funding.
• Children under 15 years may be eligible for therapy funding only if they have a prior diagnosis of ASD or PDD.

What Should I Do If I Suspect My Child Has ASD or PDD?

1. Visit your General Practitioner (GP) – They can assess your concerns and provide a referral to a Paediatrician or Psychiatrist if further investigation is needed.
2. If appropriate, the specialist may refer your child to an Allied Health Professional (e.g. Speech Pathologist, Psychologist, or Occupational Therapist) for assessment and/or treatment.
3. You may request a referral to a specific clinic or provider if you have a preference.

Already Have a Diagnosis or Accessing Services?

If your child has an existing diagnosis or is already receiving early intervention support:

• Your child’s Consultant Paediatrician or Psychiatrist can provide a referral to an Allied Health professional to access the Medicare rebate.
• If you’re seeing a provider privately, ask your doctor to refer you to your current service provider so you can claim the available rebate.

How Much Is the Rebate?

• The current Medicare rebate is $75.95 per session.
• Once payment has been received, an invoice will be issued. After payment is confirmed, we will mark the invoice as paid (closed) and return it to you. You can then use this finalised invoice to submit a claim online to Medicare.

Where Can I Find More Information?

For further details, visit the https://www.health.gov.au/our-work/national-roadmap-to-improve-the-health-and-mental-health-of-autistic-people-2025-2035 or speak to your healthcare provider.