Internationally, over the past two decades the theme of personalisation has driven significant reforms within health and social care services. In the Australian context, the principles of ‘entitlement based on need’ and ‘personalisation’ frame the proposed National Disability Long-Term Care and Support Scheme (LTCSS). In this article, we critically examine the interpretations and ambiguities of need and personalisation. We consider the administrative complexities of applying these principles in practice and the uncertainties about the roles of state and the market, and use individual case examples to illustrate areas of potential tension. Whether principles translate to deliver personalised services and avoid harmful trade-offs between access, equity and choice is the true test of social policy.