The National Disability Insurance Scheme has failed in remote Indigenous communities across northern Australia, a royal commission has been told.
The market-based model relies on funding for disabled people's care driving the growth of service provision, Northern Territory Public Guardian Beth Walker told the disability inquiry on Tuesday.
"The market has not responded and so people's needs are not being fully met because of the lack of availability of services," she said at the hearing in Alice Springs on Tuesday.
"It is difficult for service providers given remote distances and there is market failure."
Ms Walker said the choice between providers that delivered basic services in remote and very remote communities was marginal or non-existent.
Communicating with the scheme was also difficult.
"The scheme is very transactional and very bureaucratic and can be very difficult to navigate," she said.
"It is often very difficult to find the right person to talk to, to point you in the right direction."
Ms Walker said overcrowded housing and homelessness was also an issue for many disabled people in remote Indigenous communities.
She said some people were unable to start their well-funded support packages because they did not have a permanent address.
"That is very poor state of affairs," Mr Walker said.
It also limits access to therapy solutions because medical staff often cannot find suitable accommodation in communities.
"When we are talking about people with high disability needs it means that housing is a critical issue," she said.
Ms Walker said some people were forced to leave their remote communities to find care, severing their ties to their country and culture, which ultimately cost taxpayers more money.
"Disconnection causes more problems ... increased depression, increased problems with mental health ... increased anti-social or problematic behaviours," she said.
The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability is examining the treatment and experiences of thousands of Indigenous people with disabilities in remote communities.
Barriers to accessing the NDIS and disability services are among the issues being covered during the five-day sitting in Alice Springs.
It is also considering whether those hurdles cause or contribute to violence, abuse, neglect and exploitation of Indigenous people with disabilities.
Earlier, the inquiry heard that a wheelchair-bound Indigenous woman's life in a remote community became tougher after the NDIS started.
Mother-of-three Emily Sherwood lives in a one-bedroom flat in Tennant Creek, 510km north of Alice Springs, that is so small her mobility scooter does not fit through the door.
Ms Sherwood, who lost her ability to talk when she had a stroke, was critical of the scheme as she gave evidence by nodding her answers.
She agreed that despite being given a funding plan, no one from the National Disability Insurance Agency, which administers the scheme, had explained it to her or given her the opportunity to make decisions about how the money would be spent.
The inquiry heard Ms Sherwood's situation had deteriorated since the NDIS started and she would have had better disability support under the previous model.
There are about 66,000 Indigenous people with a profound or severe disability in Australia.
Of those, about 11 per cent or roughly 7000 people live in remote or very remote areas, according to the Australian Bureau of Statistics.
Australian Associated Press