The National Disability Insurance Scheme (NDIS) is a national approach to lifetime support for people with significant and complex needs and involves a shift from the previous system of targeted disability support to a universal insurance-based approach. The NDIS governance principle is that funding provides ‘reasonable and necessary’ supports coordinated with mainstream disability, health and community services within a quasi-market. This is an immense operational challenge, especially given the wide scale organisational upheaval, multiple organisational types, new market entrants, and boundary confusion between the NDIS and other services and sectors. It requires significant effort from organisations, frontline workers and participants to adapt to a broader, more complex system where interface challenges must be negotiated or risk ineffective and fragmented responses to people with complex health and multiple needs across services and sectors.