Tightening NDIS eligibility will disproportionately affect women – in more ways than you’d expect

Public hearings are underway this week to highlight the impacts of the government’s new National Disability Insurance Scheme (NDIS) bill to tighten eligibility and save costs. Over the past two days, the Senate inquiry heard that if the bill passes in its current form, it risks entrenching gender inequities in the NDIS and further excluding women and girls. We have long known the NDIS has a gender problem . Women and girls only make up 38% of the scheme . Men outnumber women in every age category (except for 55 and over) and dominate nearly every disability type within the scheme. From the age of 15, access requests from men are also approved at a higher rate than access requests for women. Tighter eligibility From January 1 2028, the bill will require scheme applicants to access all “appropriate” treatments (meaning known, evidence-based and available in Australia) likely to “materially” (meaning noticeably) improve or alleviate the impact of the impairment, before NDIS access is granted. Applicants have always been asked to demonstrate they’ve tried other treatments before applying for the NDIS. But this new rule is likely to place an even higher burden on people with impairments that are difficult to diagnose and medically complex to treat. Under the new permanency rules, people may have to try lots of potentially marginal treatments that might slightly improve functioning, even if their conditions are not understood, or the treatment is expensive or difficult to access. Women are more likely than men to have medically unexplained or chronic conditions , such as myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia , which causes chronic pain. These “pay to prove” dynamics also disproportionately affect those with fewer financial resources. Women with disability are more likely than men with disability to live on lower incomes . They also have higher expenses and lower earning capacity due to greater caring responsibilities. Tightening access to the scheme in this way – without first addressing costly and difficult-to-access treatment pathways – risks excluding these women and girls from key supports. Support can only be provided for approved conditions If the bill passes, the NDIS will only fund supports for needs that directly relate to NDIS-recognised impairments. This reverses changes to NDIS legislation introduced two years ago , which better recognised the complex way people actually experience impairments. We have spoken to people in our current study about chronic pain who have explained that pain from one condition (for example, a connective tissue disorder) can affect the functional impacts of another impairment (for example, autism or a psychosocial disability , for which they receive NDIS support). For them, it’s impossible to distinguish between support needs “arising directly” from their NDIS-recognised impairment and support needs that are indirectly related to that impairment. Women are also more likely than men to experience multiple chronic health conditions and disabilities, especially in age groups under the NDIS cut-off of 65. Narrowing the lens of assessment and restricting access in this way also has gendered consequences. Cuts to social participation funding The bill gives the minister power to make cuts to entire categories of supports in the future, without introducing legislation or consultation. We got a taste of what this could look when the government announced it would cut participants’ social and community participation budgets. The 50% across-the-board cuts will shift these responsibilities back onto informal carers – largely women. There are more than twice as many female primary carers as male primary carers. Of those providing primary care to children with disability, the overwhelming majority (84.7%) are women. Some 43.8% of primary carers also have disability themselves. This means that when it comes to carers, we are often talking about women with disability who are the primary carers for children with disability. These cuts will increase unpaid caring responsibilities. The bill’s explanatory memorandum acknowledges this: Due to the gendered nature of caring, women are more likely to be impacted by changes to the supports available […]. These changes may lead carers to cut back on paid employment, deepening women’s socioeconomic exclusion. Cuts to social and community participation funding are also likely to increase social isolation and reduce natural safeguards of community connection for people with disability. Women with disability are disproportionately likely to experience violence, so cutting them off from vital community participation supports poses an unacceptable risk. What needs to be done? The bill’s explanatory memorandum says: opportunities to increase gender equality will be considered as part of the design and evaluation of future market