As of 12:01 Wednesday morning, the US government has shut down.
The shutdown, the first since 2018, came about because congressional Democrats and Republicans cannot agree on a spending bill. A key line in the sand: Democratic leaders want to expand 2021 enhanced Affordable Care Act (ACA) premium subsidies while Republican leaders want to allow them to expire at the end of the year.
If they expire, premiums are expected to spike for the 24+ million people enrolled in the ACA marketplace, according to a KFF report, and providers are expected to lose billions in revenue, per a recent report from nonprofit Robert Wood Johnson Foundation.
In the meantime, as Congress dukes it out, healthcare is going to look a little different.
Hospital-at-home. For one, without a spending plan, several pandemic-era Medicare flexibilities are no longer in effect.
A 2020 waiver allowing hospitals to deliver inpatient care to Medicare patients at home expired Oct. 1.
As of July 2025, 400 hospitals across 142 systems and 39 states were approved to provide hospital-at-home services, according to a July American Hospital Association (AHA) fact sheet.
The Centers for Medicare and Medicaid Services (CMS) ordered all hospitals with active waivers to discharge their hospital-at-home patients or return them to the hospital on Sept. 30, according to an alert on the agency’s page.
This pause may “hamper long-term progress for the hospital-at-home program,” AHA spokesperson Colin Milligan told Healthcare Brew.
Telehealth reimbursement. Flexibilities that reimbursed telehealth care for Medicare beneficiaries at their homes regardless of where they lived also expired Oct. 1, despite advocacy from industry groups.
Now, many Medicare patients must take telehealth appointments from locations such as a provider’s office or skilled nursing facility within a rural health professional shortage area, a federal telehealth demonstration project, or in a county that isn’t in a metropolitan statistical area.
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Exceptions are made for behavioral health and substance use treatment and for people with some other medical conditions such as kidney failure, according to the Department of Health and Human Services (HHS).
Some providers and hospital systems have reportedly started blocking these patients from scheduling visits, though some are still providing telehealth care in the hopes of later retroactive payment, according to an Oct. 1 letter from the American Telemedicine Association’s advocacy arm, ATA Action.
ATA Action’s letter urged President Trump and Congress to extend the flexibilities and enact a retroactive telehealth reimbursement program so those medical professionals can be reimbursed.
“Medicare patients woke up this morning without telehealth coverage for the first time since the pandemic, five years ago. Our healthcare services are regressing, falling woefully short for millions of patients in need,” Kyle Zebley, executive director of ATA Action and SVP of public policy at ATA, said in an Oct. 1 press release.
Federal services decrease. HHS contingency plans for a government shutdown involve furloughing 41% (32,460) of staff “as of day two of a funding lapse.” About 59% (47,257) will stay on to conduct essential activities such as monitoring for disease outbreaks, conducting crucial research and clinical tasks, and reviewing drug and medical devices.
Medicare and Medicaid payments will continue, and CMS has enough cash on hand to fund Medicaid through Q1 2026, according to a CMS contingency plan. But some survey activity, contract oversight, and beneficiary casework has been paused.
The FDA, meanwhile, will not be accepting new drug applications during the shutdown, according to the agency’s contingency plan.