"Reasonable and necessary" supports

The phrase that runs the scheme

"Reasonable and necessary" is the phrase the NDIA uses to decide whether a support gets funded in your plan. If a support fits, the NDIA can fund it. If it doesn't, they can't — at least not under the NDIS.

It sounds vague, but there are actually six tests set out in the NDIS Act, and any support a planner approves has to pass all of them.

The six criteria

A support is reasonable and necessary if it:

1. Helps you pursue your goals — the ones in your plan.
2. Helps you take part in social, economic or daily life — work, study, community, household.
3. Represents value for money — relative to the benefit it gives.
4. Is likely to be effective and beneficial for you — based on evidence and current good practice.
5. Takes into account informal supports — what family, friends and community already provide.
6. Is most appropriately funded by the NDIS — not better funded by the health system, education, or another scheme.

How to talk about supports in those terms

When you're describing a support in a planning meeting or in writing, link it back to the criteria above. Some examples:

• "My goal is to live more independently. A support worker for two hours a morning would help me build a routine I can manage long-term — that's value for money compared to a higher-cost intervention later." (Goals, value for money, beneficial.)
• "My OT recommends I practise transfers daily between sessions. A trained worker doing this with me is the most effective way to consolidate the therapy." (Effective, beneficial.)
• "My partner provides most of my care, but they work three days a week. I need a worker on those days." (Informal supports considered.)

Common myths

• "It has to be the cheapest option." — Not exactly. It has to be value for money given the benefit. A more expensive support can be reasonable if it works better.
• "If a friend does it for me now, it'll never be funded." — Not necessarily. Informal supports are considered, but they're not required to keep doing everything for free.
• "Only therapy and equipment get funded." — Support worker time for everyday activities is one of the most common funded supports.

If something is refused

The NDIA must give reasons. Often the issue is missing evidence rather than the support itself — adding a recent report from a treating professional often turns a "no" into a "yes" on review. See Preparing for your plan review for how to bring evidence to the table.