What are the proposed NDIS treatment-exhaustion requirements and when would they take effect?

The proposed amendments would require NDIS applicants, from January 2028 if passed, to demonstrate they have exhausted 'appropriate' evidence-based treatments that might 'materially' improve their impairments before accessing the scheme. The legislation also proposes narrowing funded supports to those arising directly from a single recognised impairment, reversing provisions that previously allowed the scheme to consider how multiple conditions interact. These are proposed changes — they have not passed parliament as of June 2026.

Which conditions are most affected by the proposed treatment-exhaustion requirement?

Researchers from UNSW and ANU highlight conditions where the evidence base is contested or where standard treatments are inaccessible: ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) and fibromyalgia are explicitly named, as the recommended treatments are debated and many patients report that prescribed treatments worsened their condition. Complex multimorbidity — where several chronic conditions interact — is also flagged, as the proposed narrowing of support eligibility penalises interacting rather than single-impairment presentations.

NDIS eligibility tightening will hit women with chronic illness hardest

What just happened

Proposed amendments to the National Disability Insurance Scheme Act, currently before parliament, would require NDIS applicants to exhaust “appropriate” evidence-based treatments that might “materially” improve their impairments before gaining access to the scheme. Researchers from UNSW Sydney and the Australian National University have published an analysis arguing the changes will disproportionately harm women — and that the legislation’s explanatory materials acknowledge the gendered impact without providing meaningful accountability or analysis.

The proposed changes are substantial. They include:

An enhanced treatment requirement, effective January 2028 if passed, requiring applicants to exhaust specified treatments with a defined evidence base before applying
A narrowing of what supports the NDIS can fund, restricting eligibility to needs arising directly from a single recognised impairment — reversing provisions that previously allowed funding to consider complex interactions between multiple conditions
Expanded ministerial discretion to reduce entire support categories without legislative review
A 50% across-the-board cut to community participation budgets already announced

The Victorian government accepted a broader Rapid Review into the NDIS in May 2026. The legislative amendments are the formal mechanism for those changes.

The both-and

The fiscal context for this legislation is real. The NDIS has grown significantly beyond its original projected cost envelope, and questions about scheme sustainability are legitimate policy concerns. The debate is not whether any reform is warranted — it is whether the specific mechanisms being used distribute the cost equitably, or place it disproportionately on populations that were already disadvantaged within the scheme.

Why women are underrepresented to begin with

Women currently make up only 38% of NDIS participants despite representing approximately half the disability population. This gap is not random — it reflects documented patterns in how disability is assessed, how chronic conditions are diagnosed and treated, and how the scheme’s original eligibility framework was designed. Women with disability are underrepresented in the scheme relative to their population, meaning they are already accessing less than a proportionate share of scheme resources.

The proposed treatment-exhaustion requirement adds a new eligibility barrier on top of an existing access deficit.

The conditions that will be hardest hit

The UNSW and ANU researchers explicitly name ME/CFS and fibromyalgia as conditions where the treatment-exhaustion requirement will create the most significant barriers. Both conditions:

Affect women disproportionately
Carry long diagnostic delays — sometimes years from symptom onset to diagnosis
Have contested evidence bases for recommended treatments
Include conditions where some patients report that recommended treatments worsened their condition

An applicant with ME/CFS would be required to demonstrate they had exhausted “appropriate evidence-based treatments” in a field where clinical guidelines are actively contested and where the definition of “appropriate” is not yet settled. This is not a theoretical concern — it is a specific administrative barrier for a specific population.

Complex multimorbidity compounds this further. The proposed narrowing of eligible supports to needs arising from a single recognised impairment — rather than the interaction between multiple conditions — effectively penalises the clinical presentations most common in women with multiple chronic conditions. A woman managing fibromyalgia, anxiety, and a sleep disorder simultaneously would find that the interaction between those conditions could no longer drive support eligibility, only each condition individually.

The carer cascade

This is where the impact extends beyond individual NDIS participants. Women constitute twice as many unpaid carers as men in Australia. Among carers for children with disability specifically, 84.7% are women. The proposed 50% cut to community participation budgets would reduce structured social supports — the day programs, community activities, and social participation funding that give carers scheduled respite from care. That reduction flows directly onto the unpaid carer workforce, which is predominantly female, and many of whom are already managing their own health conditions.

The accountability gap

The researchers’ central argument is not only that the changes are harmful — it is that the legislative process has failed to complete a gender impact analysis before proceeding. The explanatory memorandum acknowledges gendered effects without providing timelines, benchmarks, or accountability mechanisms for addressing them. The NDIA had begun gender strategy work in early 2025; that work was paused to prioritise the broader reform process.

Acknowledging that a policy will disproportionately harm women in an explanatory document is not the same as designing the policy to avoid doing so.

2 cents

If you are currently on the NDIS, or considering applying, these changes are worth following — particularly if your conditions include ME/CFS, fibromyalgia, or complex multimorbidity involving multiple interacting diagnoses. The treatment-exhaustion requirement does not take effect until January 2028 if passed; there is time to engage, not a crisis requiring immediate action.

The NDIS Quality and Safeguards Commission and state-based disability advocacy networks can provide current advice on eligibility and the legislative timetable. If you are already on the NDIS, a plan review conversation with your support coordinator about how your plan might be affected is worth initiating.

For GPs: patients with ME/CFS, fibromyalgia, and complex multimorbidity who are currently on or considering the NDIS are worth a proactive conversation about the proposed changes. The “treatment-exhaustion” question — whether your patient can demonstrate they have accessed appropriate treatments — may eventually become a documentation requirement that GPs are well-positioned to support.

This is general health information, not personal clinical advice.

Verdict

Verdict: maybe — watch this.

The amendments have not yet passed parliament. But the trajectory is clear enough, and the populations most affected — women with complex chronic conditions, and the female-dominated carer workforce — are already underserved within the current scheme. This is legislation worth tracking, and worth engaging with through disability advocacy channels while public consultation is open.