What does Ministerial Direction 119 mean for employers and skilled workers in the health sector 

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Wednesday, 12 Aug 2026

On 25 July 2026, the Government introduced Ministerial Direction 119 (MD119). This Direction formally restructures the way the Department of Home Affairs processes skilled visa applications in order of priority, with direct and significant consequences for health sector employers and internationally trained clinicians.  

KEY TAKEAWAY: The practical implication of MD119 is that an applicant’s location and occupation now entirely dictate the visa wait period. Being physically in Australia at the time of application consistently places visa candidates ahead of offshore applicants, regardless of occupation.  

A. Which visa categories are impacted? 

MD119 applies to the following key visa categories: 

- Employer-sponsored nomination and visa applications:  

• Employer Nomination Scheme (subclass 186) (ENS186) 
• Skills in Demand (subclass 482) (SID482) – not including nomination transfer applications  
• Skilled Employer Sponsored Regional (Provisional) (subclass 494) (SESR494) – not including nomination transfers.

- Points-based skilled migration visa categories:

• Subclasses 189 (Skilled Independent) 
• Subclass 190 (Skilled State Nominated) 
• Subclass 491 (Skilled Work Regional) (Provisional)  
• Subclass 191 (Skilled Regional) (Permanent) 

B. How are occupations categorised? 

The Direction creates three broad groups of occupations: 

• Top priority: law enforcement and defence occupations 
• Priority sectors: healthcare, teaching and construction occupations  
• Non-priority: all other occupations 

The 5-tier processing hierarchy is illustrated below: 

Priority   Level	Occupation/Location
1	Law enforcement / defence – applicant onshore
2	Law enforcement / defence – applicant offshore
3	Construction, healthcare, or teaching – applicant onshore
4	All other occupations — applicant onshore
5	All offshore applicants

C. What are the practical implications of MD119? 

- Onshore applicants in priority sectors are afforded higher priority than those in non-priority occupations; but all offshore applicants fall within the lowest processing classification

• Healthcare occupations, including GPs, registered nurses, specialists, allied health professionals and other roles defined by the relevant ANZSCO code now sit in Priority Tier 3, provided the applicant is onshore at the time of application. This can be a meaningful advantage: An overseas-trained doctor or nurse who is already in Australia on a temporary visa at the time they lodge a SID482 or ENS186 application, will be processed ahead of the majority of applicants in the queue. 
  
  Having said that, MD119 has significant implications on regional employers and accredited sponsors. MD119 has entirely removed any priority afforded to nominations made in respect of regional positions or under an accredited sponsorship arrangement. Further, the practical implication is that an offshore medical practitioner who is nominated to work in a regional health facility is afforded lower priority than an onshore applicant nominated to work in a metropolitan city in a non-priority occupation such as marketing.  It appears MD119 has unintended consequences on critical shortages experienced in target sectors and geographical areas purely based on the physical location of the visa applicant. 
  
  The usual two-step approach (SID482 → ENS186) is now more favourable to onshore candidates. Offshore permanent applications (relevantly the ENS186 Direct Entry stream and points-based skilled visas) are moved to the lowest tier.  
  
  A significant number of health professionals seek to enter Australia through points-tested general skilled migration streams (subclasses 189, 190, 491). MD119 now presents further uncertainty of timeframes to offshore candidates, particularly those with a looming age cut-off date and particularly those in non-priority occupations. Where the SID482 and ENS186 visa categories previously provided more direct control of the immigration process, the entire cohort of offshore candidates are placed in the lowest tier. 
  
  Candidates who can easily travel to Australia on an ETA, eVisitor or working holiday visa for example, are better placed to take advantage of the new processing priorities, though these visa categories are not intended to create a bridge towards onshore lodgement of a skilled visa. 

 - The implementation of MD119 fundamentally impacts SID482 nomination and visa applications, as previous directions did not apply to this category. All on-hand SID482 nomination and visa applicants are now impacted by MD119 including pending applications which have not yet been decided

• If you or your sponsored worker already has a nomination or visa application lodged and awaiting decision, its processing position is being reassessed under the new structure right now. Health sector applications in respect of applicants already in Australia will move up the queue, while offshore candidates are moved to the lowest tier and will likely experience extended processing timelines. 

- Employers recruiting directly from overseas are now operating in a different landscape. They will experience longer wait times unless the candidate is already in Australia on a temporary visa (such as a working holiday visa, student or graduate work visa, or visitor visa) 

• Health sector employers running active recruitment initiatives from overseas need to revisit their strategy. The SID482 has generally been the preferred vehicle for international recruitment, enabling an overseas worker to mobilise to Australia as a temporary visa holder before transitioning onshore to a permanent pathway. The processing advantage now entirely depends on where the worker is located when the initial application is lodged.  
  
  Since location matters, a more considered approach should be taken when it comes to implementing a visa strategy. Employers may consider whether a sponsored worker can mobilise to Australia on a business visitor visa or subclass 400 short-stay visa, to physically apply for a skilled visa in Australia  to secure a favourable position in the queue (then later return on the skilled visa once finalised, if needed). While these visa options offer practical solutions, neither are designed to actively facilitate a further lodgement onshore. In this regard, MD119 may produce outcomes which are counterproductive to the government’s visa policies aimed at directing skilled migration though compliant employer-sponsored pathways that respond to a genuine workforce needs.  

D. What is not impacted by MD119? 

The permanent Migration Program remains capped at 185,000 places for the 2026–27 program year. This figure includes both skilled and family visa streams. MD119 does not change the number of visas available to be granted each year, just the way skilled visas are processed. 

Having said that, 70% of the Migration Program is reserved for skilled and family visa applicants already living in Australia, while the remainder is largely allocated to offshore skilled migrants. So while the overall cap is stable, the competition for offshore places has intensified considerably. For internationally trained health professionals already in Australia on a temporary visa, the structural shift toward onshore prioritisation works strongly in their favour. 

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