World

Fri Jun 27

The NDIA is changing how it pays for disability supports. What does that mean for rural communities?

Written by: Edward Johnson, Lecturer in Social Entrepreneurship and Co-Founder of Umbo, University of Sydney

Each year, the National Disability Insurance Agency (NDIA) reviews its pricing rules to ensure services funded under the National Disability Insurance Scheme (NDIS) remain sustainable.

This year’s annual pricing review ^[1] outlines changes that will take effect from July 1 2025.

Among the updates are changes to therapy pricing, travel reimbursement, and rural loadings. The NDIA says this will bring NDIS pricing in line with other government schemes and private health insurance.

But what do these changes mean for people outside the big cities?

What’s changing

Key changes include ^[2]:

adjusted therapy support rates, including a $10 per hour reduction for physiotherapists to $183.99 per hour.
travel reimbursement for therapists will be halved (from 100% to 50% of the hourly rate during any time spent travelling)
price loadings for some rural and remote areas will be removed.

The NDIA ^[3] justifies these decisions with a dataset that includes the average of hourly rates from Medicare, private health claims, and 13 other government programs.

The agency says some NDIS therapy prices exceed mainstream equivalents by up to 68%.^[4]

Why pricing comparisons don’t always translate to rural services

While these comparisons might make sense for metropolitan clinics, they do not capture the realities of service delivery in rural and remote areas.

For example, allied health professionals such as physiotherapists, occupational therapists, and speech pathologists in cities can see multiple clients in a row at one location (although this isn’t always realistic or best practice in cities either).

In contrast, rural and remote providers may drive hundreds of kilometres between appointments. Much of their time, including travel, planning, and follow-up, is essential but often unbilled.

So while $193.99 (soon $183.99) per hour for physiotherapy might look generous, it does not reflect what is left after factoring in travel and unpaid care coordination.

Disabilities are complex and often lifelong, so clinical support is time-consuming. However, that is something clinicians are passionate about – therapists so often squirm at the thought of billing our clients for anything other than direct clinical services.

The NDIA’s own data confirm most therapy providers are small operators. In fact, 90% are unregistered ^[5], and many serve fewer than five participants.

The result is a fragile “market”, particularly in towns with limited infrastructure. If pricing makes it unviable for local clinicians to offer services, the only remaining options may involve families travelling long distances or forgoing support entirely. This has knock-on effects for local economies and contributes to professional burnout and workforce shortages.

What this means for rural families

For families living in towns with limited services, travel is not optional. It is a lifeline. If providers cannot afford to travel, many people with disability simply go without ^[6].

Telepractice can be used in some clinical situations, but not all. The most effective kind of telepractice also includes support from local clinicians and coworkers, and ideally a mix of in-person and online consultations ^[7].

One family I worked with during my PhD research ^[8] lived four hours from the nearest regional centre. After an 18-month wait, their child’s therapy appointment was cancelled twice due to workforce shortages. They eventually paid privately for a service in another state.

This story is not unusual. Many families said they did not necessarily want more funding; they just wanted support delivered in ways that worked for them. Being able to access help locally allowed their children to remain part of the school community and reduced pressure on carers already juggling other responsibilities. Clinicians, communities, and families are continuing to tell very similar stories ^[9].

It is essential clinicians are able to travel to meet with NDIS clients in regional areas. Shutterstock

Is there a better way?

My research ^[10] found rural families preferred flexible models that blended telepractice with local capacity-building. These hybrid approaches worked well when supported by policy that allowed for coordination, community involvement, and some in-person time. They were not luxury add-ons. They were what made services possible.

There is also a long-term benefit in supporting local service ecosystems. When therapists can build relationships within a community, they are more likely to stay, collaborate with other professionals, and mentor early-career clinicians.

This helps reduce churn and provides continuity of care. However, with travel reimbursement and rural loadings cut, sustaining these models becomes more difficult.

What happens next?

The NDIA’s strategy includes a shift toward “differentiated pricing”, which could eventually support more tailored approaches. The Department of Social Services has also promised to offer “foundational supports ^[11]” outside the NDIS, but it is currently unclear what the nature of these supports will be. Right now, though, rural communities are being asked to absorb the reduced funding and limited flexibility. Without further adjustment, these changes risk widening the gap between metropolitan and non-metropolitan service access.

A single national price does not guarantee equal access. Equity comes from recognising and responding to different contexts. For rural and remote Australians living with disability, that recognition is long overdue.

Until then, it will be up to 7 million rural Australians to make it work for themselves in places where resources are already stretched thin.