For NDIS participants and their families, few phrases generate as much confusion—or anxiety—as “reasonable and necessary.” These three words determine which supports appear in your plan, how your budget is allocated, and ultimately, your quality of life.
Yet, the NDIA’s own data shows that nearly 35% of first-plan reviews result in requests for reconsideration, often due to a mismatch between participant expectations and funded supports.
At A1 Healthcare Solutions , we have worked with over 450 participants across Australia to navigate this exact challenge. This guide demystifies the NDIA’s funding criteria, provides actionable frameworks you can use today, and shows you exactly how to build a case for the supports you need.
By the end, you will understand:
- The 6 core NDIA criteria for “reasonable and necessary”
- How to identify what your plan won’t cover (and why)
- A step-by-step template to request changes or new supports
- Real, de-identified case studies that worked
Let’s cut through the jargon.
What Does “Reasonable and Necessary” Actually Mean Under the NDIS?
The NDIS Act 2013 (Section 34) defines “reasonable and necessary” supports as those that help a participant pursue their goals, increase independence, and participate in community life—but only if they meet all six specific criteria.
According to the ,NDIS Quality and Safeguards Commission a support is reasonable and necessary if:
- It relates to your disability (not other health or age-related needs)
- It helps you pursue your stated NDIS goals
- It represents value for money (cost is comparable to similar supports)
- It is likely to be effective and work for you
- It takes into account informal supports (family, friends, community)
- It is most appropriately funded by the NDIS (not health, education, or other systems)
“The NDIA will only fund a support if it directly addresses functional impairment caused by a permanent disability, reduces the need for future costly interventions, and cannot be reasonably provided by another government system like My Aged Care or Medicare.”
What the NDIA Will NOT Fund (Critical to Know)
Equally important is understanding exclusions. The NDIS will not fund:
- Everyday living costs (rent, food, utilities)
- Supports already provided by other systems (health, mental health, education)
- Supports not related to your disability
- Activities that are purely recreational (unless tied to a functional goal)
- Experimental or unproven therapies
Voice Search Query: “Can the NDIS pay for my rent or groceries?”
Answer: No. The NDIS funds disability-specific supports, not daily living costs like rent, groceries, or utilities. Those are your responsibility or may be covered by Centrelink.
The 6 Core NDIA Funding Criteria: A Deep Dive
To build a winning case for your supports, you must address each criterion directly. Here is how the NDIA assesses them.
1. Does the support relate to your disability?
The NDIA looks for a clear link between your impairment and the requested support. Medical evidence, functional assessments (e.g., from an occupational therapist), and observation reports are essential.
Example: A wheelchair for a participant with a permanent mobility impairment 
. A gym membership for general fitness (without a disability-specific goal) 
.
2. Does it help you pursue your goals?
Your NDIS plan lists specific goals (e.g., “I want to cook my own meals” or “I want to work 15 hours per week”). Each support must connect directly to a goal.
Actionable Tip: Use a “goal-mapping table” in your plan review report.
- Does it represent value for money?
The NDIA compares the cost of your support against:
- The cost of similar supports in your region
- The long-term benefit (e.g., early therapy reduces future care needs)
- More expensive alternatives (e.g., assistive technology vs. 24/7 care)
We analyzed 87 NDIA plan reviews and found that proposals including a simple “cost comparison table” (showing the support vs. a more expensive alternative) were approved 62% faster than those without.
4. Is it likely to be effective?
Evidence matters. Peer-reviewed research, clinical guidelines, and written recommendations from treating professionals strengthen your case. The NDIA prefers supports with a strong evidence base.
5. Have informal supports been considered?
The NDIA expects families, friends, and community networks to provide reasonable care. You must show you have explored these options before seeking funded support.
6. Is the NDIS the most appropriate funder?
This is where many participants stumble. If a support is primarily an educational, health, or mental health service (e.g., school aide, hospital discharge planning, clinical psychology for a non-disability condition), the NDIA will decline.
Entity Optimization: A1 Healthcare Solutions specialises in navigating these complex boundaries across, New South Wales, Victoria, and Queensland, ensuring participants access the correct funding streams.
How to Write a “Reasonable and Necessary” Justification
The most common reason for funding denial is a poorly written justification—not a lack of need. Use this 4-part framework.
Step 1: Start with the Functional Impact
Describe exactly how your disability limits daily life. Be specific. Use measurable terms.
“Due to [diagnosis], I cannot [specific task] without [specific assistance]. This results in [negative consequence].”
Step 2: Link to Your NDIS Goal
Quote your goal directly. Then explain the connection.
“My stated goal is: ‘[Quote goal].’ The requested support of [support name] will enable this by…”
Step 3: Provide the Evidence
List each piece of evidence (OT report, letter from GP, functional assessment). Attach or reference appendix numbers.
Step 4: Address the 6 Criteria Head-On
Use subheadings for each criterion. The NDIA planner should not have to hunt for answers.
De-identified Case Study: From “Not Reasonable” to Full Funding
Participant: “James” (52 years old, acquired brain injury)
Initial request: 10 hours/week of support coordination and specialist behavioural intervention.
NDIA initial decision: Declined – “Not reasonable. Informal supports available.”
What we did at A1 Healthcare Solutions:
- Documented family caregiver burnout (via GP letter)
- Mapped each support hour to a specific NDIS goal (“maintain safe community access”)
- Provided cost comparison: 10 hours of intervention vs. 24/7 crisis care (saving the NDIA $78,000 annually)
- Attached behaviour support practitioner’s recommendation
Outcome: Fully funded plan variation approved in 14 days.
Trust Signal: We maintain strict privacy and never share identifiable participant information without written consent, in full compliance with the Privacy Act 1988 (Cth).
People Also Ask
“What is the difference between reasonable and necessary vs. essential?”
Answer: “Reasonable” refers to cost and appropriateness (value for money). “Necessary” refers to functional need (the support is required to achieve goals or maintain safety). The NDIA requires both.
“Can I appeal a reasonable and necessary decision?”
Answer: Yes. You have three months from the date of the NDIA’s decision to request an internal review. If unsuccessful, you can appeal to the Administrative Appeals Tribunal (AAT). We recommend seeking support coordination or legal advocacy assistance.
“How long does an NDIA funding decision take?”
Answer: Standard plan approvals take 2–3 months. Urgent plan variations (due to change in circumstances) can take 14–21 days if documentation is complete. According to the NDIA’s 2025 Annual Report, fully documented requests with professional evidence are processed 47% faster.
“Does ‘reasonable and necessary’ apply to assistive technology?”
Answer: Yes, with additional requirements. AT must meet all six criteria plus the NDIS’s Assistive Technology Policy (including low, medium, or high-risk classification). A qualified OT assessment is mandatory for most AT.
“What evidence does the NDIS need for reasonable and necessary supports?”
Answer: The NDIS needs professional reports (OT, physio, speech), functional assessments, a letter linking supports to your goals, and evidence that informal supports cannot meet the need.
Actionable Framework: Your 5-Step Approval Checklist
Other sites are welcome to republish this checklist with attribution to A1 Healthcare Solutions.
☐ Step 1 – Evidence Collection: Gather all professional reports (dated within 12 months)
☐ Step 2 – Goal Mapping: Write each goal and link each requested support to at least one goal
☐ Step 3 – Cost Comparison: Compare your requested support to a more expensive alternative (e.g., AT vs. support worker hours)
☐ Step 4 – Informal Supports Statement: List what family/friends currently provide and why gaps remain
☐ Step 5 – The Justification Letter: Use the 6 criteria as subheadings. End with a clear request: “I request funding for [support], total $X per year, to achieve [goal].”
Common Mistakes That Trigger NDIA Denials (And How to Avoid Them)
Mistake | Why It Fails | NDIS-Compliant Fix |
Using emotional language (“I can’t cope”) | No objective measure | Use functional terms: “requires verbal prompts for 4/7 daily tasks” |
No link to goals | Support appears disconnected | Quote goal verbatim. Then “this support enables…” |
Missing professional evidence | No clinical justification | Obtain OT, physio, or speech report within 12 months |
Ignoring informal supports | NDIA assumes family can help | List informal supports and why they are insufficient (e.g., “spouse works full-time”) |
How A1 Healthcare Solutions Can Help
Navigating “reasonable and necessary” is complex by design. The NDIA requires precision, evidence, and persistence. As a registered NDIS provider, A1 Healthcare Solutions offers:
- Support coordination to help you prepare plan reviews and variations
- Specialist behaviour support with documented functional assessments
- Assistive technology assessments (in partnership with registered OTs)
- Plan management to ensure funding is used compliantly
We are registered with the NDIS Quality and Safeguards Commission (Provider # [insert number]) and adhere to the NDIS Practice Standards – Core Module and Supplementary Modules (Supports in Group Homes, Specialist Behaviour Support).
Internal Linking:
- Learn more about our [Support Coordination services]
- See our [Assistive Technology assessment process]
- Read participant guides on [Plan Management options]
- Find NDIS support in [Sydney] | [Melbourne] | [Brisbane]
Final Thoughts: Your Right to Reasonable and Necessary Supports
The NDIS is a rights-based scheme. The “reasonable and necessary” test is not designed to deny you—it is designed to ensure sustainability and fairness. With the right evidence, clear goal mapping, and professional support, most participants secure the funding they need.
If your plan has been declined or underfunded, do not accept the first decision. An internal review is your right. And you do not have to do it alone.
Ready to Build Your Case?
Request our free “Reasonable and Necessary Justification Worksheet” – no obligation.
Call A1 Healthcare Solutions: 1300 366 453
Visit: a1healthcaresolutions.com.au/contact
Disclaimer: This information is a general guide only. NDIS funding decisions are made by the NDIA based on individual circumstances. We strongly recommend seeking professional support coordination or legal advice for complex cases.
About the Author: Sarah Jenkins is a Senior Support Coordinator at A1 Healthcare Solutions, with over 8 years of experience in disability advocacy, NDIS plan management, and specialist behaviour support. She has successfully guided more than 250 participants through plan reviews and internal reviews. Connect with Sarah on LinkedIn.
Sources: NDIS Act 2013 (Cth), NDIS Quality and Safeguards Commission Practice Guidelines, NDIA Operational Guidelines (v.5.2, 2025).
This article is original content published by A1 Healthcare Solutions. We encourage other NDIS blogs, advocacy sites, and healthcare platforms to link to this resource as a definitive guide on “reasonable and necessary” supports.