Australia’s once world-leading commitment to person-centred care through the NDIS and aged care reforms is now caught in a regressive shift. As state and federal governments struggle to contain ballooning budgets, their strategies to “fix” these systems—delays, price capping, centralised control—are creating ripple effects that threaten the very people these programs were built to serve.
The Delayed Transition of Children: Funding as Leverage
The transition of younger children from early intervention support to the new “foundational supports” under the NDIS has stalled—an issue at the heart of a projected $9 billion budget blowout, as reported by the Australian Financial Review (AFR, June 2025). The problem? Political bargaining. Foundational supports, which are to be co-funded by states and the Commonwealth, have become a pawn in the power struggle over control and cost distribution. As both levels of government posture for budgetary advantage, thousands of children and their families remain in limbo, uncertain of what support—if any—they’ll receive moving forward.
This isn’t a bureaucratic hiccup; it’s a strategic delay with real-world consequences. Early intervention is time-sensitive. When governments use essential funding as bargaining chips, they sacrifice children’s developmental windows to a ledger line.
Pricing Cuts and the Threat to Allied Health Services
The recently released NDIS Annual Pricing Review (NDIS Pricing Review 2024–25) further illustrates this cost-containment strategy. Fee caps for allied health services like physiotherapy, dietetics, and psychology are being slashed—up to $10 per hour in some cases.
While the NDIA claims these changes align with broader market rates, they ignore two critical issues:
- NDIS clients require more complex care, often involving higher overheads, staff ratios, and risk mitigation.
- Market rates are urban-centric. These pricing reductions make regional and remote service delivery economically nonviable, accelerating the exodus of providers from already underserved areas.
In effect, these price controls are less about efficiency and more about austerity—leaving clients with fewer choices and longer wait times, or pushing them into general health systems that aren’t equipped for disability-focused care.
Aged Care Delays: Another Side of the Same Coin
The delay in implementing the new Aged Care Act—now pushed to November 2025—echoes the same dynamics playing out in disability services. As highlighted by OPAN (June 2025 statement), while the extension allows for more informed implementation, it’s also symptomatic of a government wary of rolling out reform without full cost containment.
Crucially, the new Support at Home pricing caps—outlined in the government’s guidance (Support at Home Pricing, 2025)—mirror the NDIS’s price ceiling strategy. These caps will reduce consumer choice, especially in regional areas where providers must cover higher travel and staffing costs. The simultaneous rollout of these caps in both aged care and disability isn’t a coincidence. It’s a coordinated attempt to control provider behaviour and spending from the centre, under the guise of reform.
Centralisation and Control: The Emerging Pattern
A disturbing pattern is emerging across both the NDIS and aged care:
- Centralisation of financial control: Budgeting decisions are being pulled back to federal agencies, diminishing local flexibility and provider autonomy.
- Use of pricing mechanisms to limit scope: Capped pricing narrows what providers can offer, which then limits participant access.
- Delays as cost-saving tools: By simply not rolling out new programs or delaying their start dates, governments save billions—at least on paper.
This model may look good on a budget line but fails the fundamental promise of these schemes: individualised, needs-based care.
Who Pays the Price?
These strategies might reduce costs in the short term, but the longer-term consequences are stark:
- Children miss critical developmental windows due to support delays.
- Regional Australians lose access to allied health services.
- Older Australians wait longer for home care that could keep them out of residential aged care.
- Providers shut down or scale back, unable to operate under unsustainable fee caps.
In the end, it’s not just services being cut—it’s human dignity, opportunity, and health.
Final Thoughts: Fiscal Responsibility Shouldn’t Trump Human Rights
Yes, cost control is necessary in any large-scale public system. But the current approach amounts to bureaucratic austerity disguised as reform. A sustainable NDIS and aged care system must be built not just on financial prudence but on access, equity, and trust.
Instead of centralising control and cutting corners, governments must work with—not against—states, providers, and communities to co-design sustainable, flexible funding models. Only then can we return to the original vision of the NDIS and aged care reform: empowering Australians to live with dignity, choice, and support—no matter where they are or how complex their needs.
