A support is “reasonable and necessary” — and can be funded by the NDIS — when it meets the six criteria set out in section 34 of the NDIS Act: it helps you pursue your goals, helps you take part socially and economically, is value for money, is likely to be effective, accounts for the support your family and community provide, and is best funded by the NDIS rather than another system. On top of that, the support has to relate to your disability and can’t be an everyday living cost.

If you’ve ever had a support knocked back and weren’t sure why, this is almost always the reason. Once you understand the six tests and the two rules that sit over them, it’s much easier to ask for the right things, back them up with the right evidence, and avoid the usual reasons requests get declined. Here’s how it works, in everyday language.

What “reasonable and necessary” actually means

“Reasonable and necessary” is the wording from the law that runs the NDIS — section 34 of the National Disability Insurance Scheme Act 2013. It’s the test the NDIA (the agency that runs the scheme) applies to every support before it goes in a plan. “Reasonable” means it’s fair and sensible to fund. “Necessary” means you genuinely need it because of your disability. Section 34 sets out six criteria, and a support has to meet all six, not just one.

A support can clearly help you and still be declined if, for example, it’s really the health system’s job, or there’s a cheaper option that does the same thing. That’s why it helps to understand each test.

The six criteria, explained

Here are the six tests from section 34, in plain English.

1. It helps you pursue your goals

The support has to connect to the goals and aspirations in your plan. That’s why your goals matter so much: they’re the anchor every support is measured against.

2. It helps you take part socially and economically

The support should help you take part in everyday life and the community, including things like work, study, volunteering and social connection.

3. It represents value for money

The cost has to be reasonable compared to the benefit, and compared to other options that would do the same job. (More on this below, because it’s widely misunderstood.)

4. It’s likely to be effective and beneficial

There should be good reason to believe the support will actually help you, in line with current good practice. Evidence such as a therapy or specialist report carries real weight here.

5. It takes your informal supports into account

The NDIS considers what it’s reasonable to expect your family, carers, networks and community to provide, and funds around that. This doesn’t mean carers are expected to do everything, but informal support is part of the picture.

6. It’s most appropriately funded by the NDIS

Some supports are the responsibility of another system: medical treatment sits with health, schooling with education, and so on. The NDIS funds disability supports that aren’t the job of those other systems.

Two rules that always apply

Alongside the six criteria, two rules sit over every funding decision:

• It must relate to your disability. The support has to be connected to your disability and the things it makes harder for you.
• It can’t be an everyday living cost. The NDIS doesn’t cover the ordinary costs of life that everyone has, such as rent, groceries or your regular bills. It can cover the extra costs that come specifically from your disability.

What the NDIS usually funds

When a support meets the tests, it commonly falls into one of these buckets:

• Help with daily living, such as personal care, household tasks and building independence.
• Building skills and capacity, including some therapies that link to your disability goals.
• Getting out into the community and taking part in activities and social life.
• Assistive technology, equipment, and home or vehicle modifications.
• Supports that help you run your plan, like plan management and support coordination.
• Supported accommodation options, where eligible.

What the NDIS won’t fund, and why

Requests usually get declined for one of these reasons:

• It’s an everyday living cost not related to disability.
• It’s really another system’s responsibility, for example clinical medical treatment (health) or school education (education).
• It doesn’t clearly link to your disability or your goals.
• There’s no evidence it will help, or there’s a more effective option.
• It costs more than the benefit justifies, or a comparable option costs less.

Knowing which test is the sticking point tells you exactly what to address if a support is knocked back.

“Value for money” doesn’t mean cheapest

This one trips people up. Value for money is about the benefit you get for the cost, not simply the lowest price. A support that costs more can still be value for money if it does more, lasts longer, or reduces the need for other funded supports down the track. The question the NDIA asks is whether the cost is reasonable for the outcome, and whether a different option would achieve the same thing for less.

How informal and mainstream supports affect funding

The NDIS works alongside two other things: your informal supports (family, friends, carers, community) and mainstream services (health, education, housing and so on). It considers what those already provide or should provide, and funds the disability-specific gap. That’s why two people with similar disabilities can end up with different plans: their goals, living situation and informal supports are different.

How to make a strong case in your plan

You can make supports much easier to approve by lining them up against the criteria before your planning meeting or review:

• Tie each support to a goal. Be clear about what you’re working towards and how the support helps you get there.
• Show the disability link. Explain how your disability makes something harder and how the support addresses it.
• Bring evidence. Current assessments and therapy or specialist reports that describe your functional needs and what works are persuasive.
• Get quotes for bigger items. For assistive technology or modifications, quotes help demonstrate value for money.
• Be ready to talk about informal and mainstream supports, so it’s clear what the NDIS is being asked to fund and why.

How a plan manager or support coordinator helps

You don’t have to navigate this alone. A support coordinator can help you understand your plan, line your supports up against the reasonable and necessary tests, find the right providers, and prepare for your plan review. A plan manager handles the financial side, paying providers and tracking your budget so you can focus on using your supports. If a review is coming up, our guide on how to prepare for an NDIS review walks through what to bring.

At SADC, our team supports participants across Greater Sydney to get the most from their plans. If you’re unsure whether a support is likely to be funded, get in touch and we’ll talk it through.

Frequently asked questions

What does “reasonable and necessary” mean in the NDIS?

It’s the legal test in section 34 of the NDIS Act that the NDIA uses to decide whether to fund a support. The support must meet six criteria — it helps you pursue your goals, helps you take part socially and economically, is value for money, is likely to be effective and beneficial, accounts for your informal supports, and is most appropriately funded by the NDIS — and it must relate to your disability and not be an everyday living cost.

What are the six reasonable and necessary criteria?

1) It helps you pursue your goals. 2) It helps you take part socially and economically. 3) It represents value for money. 4) It’s likely to be effective and beneficial. 5) It takes your informal supports into account. 6) It’s most appropriately funded by the NDIS rather than another system.

Why was my NDIS support rejected?

Usually because it didn’t meet one of the tests — most often it’s seen as an everyday cost, another system’s responsibility, not clearly linked to your disability or goals, or lacking evidence that it will help. Identifying which one is the issue tells you what to address.

Does the NDIS fund everyday living costs?

No. The NDIS doesn’t fund the ordinary costs of living that everyone has, such as rent or groceries. It can fund the extra costs that come specifically from your disability.

Who decides if a support is reasonable and necessary?

The NDIA (the agency that runs the NDIS) makes the decision, based on your goals, your circumstances and the evidence in your plan. A support coordinator can help you put that case together.

---

Written by the team at SADC Disability Services, a registered NDIS provider supporting participants across Greater Sydney from our base at 291 Belmore Rd, Riverwood. This is general information based on the NDIS Act and NDIS guidelines, not advice about your individual plan — for help with your situation, get in touch with our team.