Caught in the Middle: Navigating NDIS Pricing Pressure and Provider Sustainability

1. A permanently low-margin, high-scrutiny environment

The Federal Government has made it clear that NDIS sustainability is non-negotiable. The Financial Sustainability Framework aims to bring scheme growth down to around 8% per year—compared to more than 20% just a few years ago. 

On the surface, recent Pricing Arrangements and Price Limits (PAPL) updates appear positive. For example: 

• 3.19% then 3.95% increases for many disability support worker (DSW) supports  

• Targeted uplifts for nursing and some therapies in 2024–25  

But a broader view tells a different story. 

• NDS reports that in 2024–25, 63% of organisations made a loss or only broke even, with just 35% reporting a surplus  

• Ability Roundtable benchmarking suggests average profitability of around –2.1%, with over 60% of providers recording three consecutive years of losses, and a 10.9% gap between the DSW cost model and actual costs  

In other words, many providers are already operating on a knife-edge, as prices flatten while wages, compliance, and overheads continue to rise. 

Where the opportunity lies 

In a low-margin environment, providers who succeed tend to: 

• Understand their true cost-to-serve by service, region, and cohort  

• Eliminate leakage from under-billing, miscoding, and avoidable write-offs  

• Use technology to automate pricing rules (caps, travel limits, cancellations), freeing teams to focus on care  

This is where modern NDIS-aware platforms like Nightingale become strategic—not just operational. 

2. Real-terms cuts in key service lines

Not every price change is an uplift. Two areas in particular are feeling the pressure. 

2.1 Intermediaries: support coordination and plan management 

Support coordination and plan management sit at the centre of many reforms—helping participants navigate increasingly complex systems. Yet their pricing tells a different story. 

Recent PAPLs have introduced: 

• Multiple years of effective price freezes  

• From 2025–26, no uplift for plan management, alongside the removal of remote loadings and set-up fees  

In real terms, this amounts to a price reduction when factoring in inflation and wage growth. Sector bodies like NDS highlight that these roles also carry significant unbillable work and safeguarding responsibilities not reflected in pricing caps. 

2.2 Therapy, allied health, and travel 

Therapy has also been a major focus of reform: 

• NDIA has standardised psychology and therapy rates nationally, reducing higher caps in some areas  

• Some NDIS therapy caps were previously up to 68% higher than mainstream markets, prompting efforts to remove the “NDIS premium”  

• From 1 July 2025, therapy travel labour claims are capped at 50% of the hourly rate, with existing time caps retained  

For outreach and regional providers, where clinicians may spend hours travelling, this is a direct hit to revenue. Combined with workforce shortages and rising wages, it raises real questions about long-term service viability in some areas. 

Where the opportunity lies 

For intermediaries and therapy providers: 

• Every percentage point of utilisation matters  

• Leakage from incorrect pricing, travel claims, or cancellations is no longer sustainable  

• Clear visibility on profitability by service, worker, and location is essential  

In response, providers are: 

• Using automated PAPL updates and rules engines to ensure accurate billing  

• Improving travel-aware rostering to reduce unclaimable time  

• Leveraging service-line reporting to identify where offerings need to be redesigned, repositioned, or exited  

3. New planning rules, budgets, and “NDIS supports” definitions

Legislative reform is another major shift. 

The National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Act 2024 reshapes how plans and budgets will operate over the coming years. It introduces: 

• A formal definition of “NDIS supports,” including clearer boundaries on what can and cannot be funded  

• New framework plans with total funding amounts (rather than detailed line items), linked to needs and funding periods  

• Stronger claims and payment rules, including tighter compliance and debt-recovery mechanisms  

Under these changes: 

• Funding is typically set for up to 12 months  

• Spending cannot exceed allocated budgets, and unused funds won’t roll over  

• Overspending—even unintentionally—can result in debt  

While these reforms bring greater structure, they also raise concerns about access to supports and increased complexity for both participants and providers. 

What this means for providers 

• Greater revenue volatility, particularly for those reliant on a small number of high-value plans  

• Increased risk of delivering unfunded services without real-time visibility  

• A stronger need for clear authorisation and budget tracking processes  

Where the opportunity lies 

Providers getting ahead are: 

• Centralising plan, budget, and utilisation data  

• Monitoring budgets in real time to prevent overspend  

• Strengthening service agreements and internal controls without slowing down care  

Nightingale is designed with this level of visibility and control in mind—across participants, programs, and the broader organisation. 

Across the sector, providers are facing the same pressures—trying to balance sustainability with the delivery of quality care. There’s no quick fix, but there are ways to reduce the load. 

It’s not a lack of commitment—if anything, it’s the opposite. Providers are holding the system together, often at their own expense. 

At the heart of the challenge is a difficult balancing act. 

On one side are evolving policies, pricing constraints, and compliance requirements that demand more structure, reporting, and control. On the other are participants—people who rely on consistent, flexible, high-quality support to live their lives. 

When funding doesn’t fully reflect the reality of care, providers are left to bridge the gap—whether through going above and beyond in service delivery, absorbing additional admin, or stretching already thin teams. Over time, that gap becomes increasingly difficult to sustain. 

In this article, we unpack the key NDIS funding and pricing changes affecting providers in 2025–26, the practical challenges they create on the ground, and where platforms like Nightingale are helping providers respond.