Small NDIS allied health providers: keep moving, and don’t give up

State of play:

As at the end of November 2025, NDIS reforms include lots of parts, uncertainty, and complexity.

Unknown unknowns:

Small allied health providers must plan for 2026. But how can we make decisions about strategy, services, marketing, recruitment, training, compliance, resources, and finances with so many balls up in the air?

Chessboard fallacy:

More than 250 years ago, Adam Smith warned us not to look at policy reforms as a game in which governments rearrange people like chess pieces. We make better decisions if we accept that every person and organisation affected by NDIS reforms has their own goals, incentives and biases (including us).

Not about us, or “us versus them”:

It sometimes feels like small providers have been targeted for elimination. But the stakes are much higher for participants. And we shouldn’t assume governments, regulators, the media, large providers or others are acting with malice. We all want better value services and outcomes for people with disability. We all want the NDIS to survive.

So what do we expect in 2026, and why?

1. Increased NDIS allied health funding pressures as:

participants lose scheme access through eligibility reassessments;
children with ‘mild and moderate autism or developmental delay’ are diverted to Thriving Kids (see below);
the early intervention pathway is abolished for most kids;
new plans are approved with tighter funding controls;
I-CAN support needs assessments roll out for participants aged 16 and over (perhaps with algorithmically-determined funding);
the permanent definition of “NDIS supports” is released and implemented;
the NDIS Evidence Advisory Committee’s Capacity Building and Therapies Subcommittee scrutinises the cost-effectiveness and quality of evidence for different therapies (including dosages);
recommendations emerge from the therapy pilot (commencing in January 2026) to “better understand costs and characteristics of quality service delivery”. (Controversially, this was commissioned through a closed, non-competitive tender that locked out small providers); and
additional/differential pricing limits are imposed for different types of therapy, and travel (e.g., the new price limits for music and arts therapists from 24 November 2025).

2. Continued government and media narratives about “dodgy providers” and “unregistered cowboys”

Politicians conflate “unregistered providers” with bad actors and fraudsters to maintain public and taxpayer support for urgent reforms.
Large registered providers – with very real profitability challenges – continue to run the “unregistered = dodgy cowboy” line because it helps them lobby for special pricing arrangements, mandatory registration of all providers, and taxpayer bailouts. They know these changes would drive more small allied health providers out of the sector and reduce competition – and participant choice.
Allied health professionals are regulated. Duplicative rules increase costs and distract from service delivery, which is why we endorse the NDIS Provider and Worker Registration Taskforce 2024 recommendation to “deem registration” of allied health providers based on existing allied health regulations plus worker checks.

3. More small providers will exit the sector, but others will adapt and keep going

On 24 November 2025, the NDIA said that, as the market matures, some providers will decide to stop delivering all or some sorts of NDIS supports.
In June 2025, the Independent Pricing Committee predicted much the same thing, recognising that pricing limits make it difficult for small allied health clinics with staff to remain viable (see links).
We are not powerless pawns. Lots of small providers are advocating for “reforms to the reforms”, making submissions to consultations, meeting with MPs, working with peak bodies, unionising, and/or supporting disability advocates and affected participant groups.
No one is going to bail out insolvent small allied health providers – and nor should they. Over the last 18 months, many providers have worked hard to reduce their dependence on NDIS funding. Unavoidably, this has reduced access to therapy for participants in some areas.

4. Families will be underwhelmed by Thriving Kids programs and outcomes

Thriving Kids, not yet agreed, looks like a return to block-funded programs, general strategy-sharing, parent training, and (possibly) short interventions, perhaps in groups.
Evidence-based early intervention programs, like Inklings, show promise. Outcome data for school programs are much less compelling (see links).
We don’t know who will deliver Thriving Kids programs ‘on the ground’, although we expect large registered providers (with subcontractors), and/or state government employed workers.

5. New allied health service gaps will emerge

Public disability, health and education systems in many states are under stress.
Funding systems are built on the false premise that people’s disability, health and education needs are unrelated:
- If you have a disability or have worked for a person with disability or delay – an autistic toddler, a dyslexic teenager, a young adult with cerebral palsy, an older adult with Parkinson’s disease, for example – you know this is untrue.
- Health, education and disability systems and budgets are interdependent, which explains, in part, why governments have handcuffed Thriving Kids to the 5-year public hospital deal negotiations.
- State governments, like NSW, continue to consult on “Foundational Supports” (talking about the same cohort of kids as Thriving Kids). Thriving Kids may look very different state-to-state, region-to-region.
Overall demand for allied health services remains high. But the allied health workforce is limited, especially in rural and remote settings.
Many allied health providers work across multiple systems and will split their resources based on client demand, professional interests and skills, and system incentives. In states like NSW, health and education bureaucracies don’t always get along, and working between systems is inefficient, with access and other real world logistical challenges.
A large chunk of the allied health workforce with disability experience is employed in the private sector because of the way the NDIS used to work. As the model changes, the workforce and employers will adapt. But this will take time, and new service gaps will emerge.

6. Provider legal and compliance risks and costs will increase

Legal and compliance risks for providers, owners and managers have steadily increased over the last two years.
If enacted, the new NDIS reform bill (released on 26 November 2025) will further increase risks for all providers (not just the “fraudsters and cowboys”).
Expect insurance premiums to rise, too.

7. A flight to quality?

Regardless of funding models and business pressures, we can’t cut corners if we want to succeed:

Clients deserve excellent services: including safe, timely, evidence-based, client-centred, convenient, and high quality services.
Our staff deserve respect: Professionals want to learn, to belong, to create, to grow, and for their work to have an impact. They need to be trained and supervised properly. They need the right resources to deliver great services that produce real outcomes for clients.

Bottom line:

Small allied health providers that deliver quality services to participants while supporting teams should feel proud of their hard work this year and take heart. As 2026 approaches, we should back ourselves to compete on quality and outcomes with large providers, and to provide participants with real choice and control.