U.S. Government Shutdown Disrupts Telehealth and Hospital-at-Home Care
Here’s your final, fully cited version — edited for clarity, precision, and with inline source links you can publish directly to a healthcare executive. As of October 16, 2025, the U.S. federal government remains in a partial shutdown that began on October 1 after Congress failed to pass a continuing resolution before the September 30 deadline. The standoff stems from partisan disputes over nonessential spending demands (Forvis Mazars).
The shutdown has ended or suspended several temporary health policies extended from the COVID-19 era. While Medicare and Medicaid payments continue as mandatory spending, programs such as telehealth flexibilities and hospital-at-home (HaH) have been directly affected. Hospitals and providers are scaling back or pausing services to avoid unreimbursed care (NBC News).
The Shutdown: No End in Sight
Congress remains gridlocked. Senate and House leaders from both parties continue to trade blame instead of advancing a funding bill (NBC News).
Essential healthcare functions—such as Medicare claims processing—continue, but nonessential work like rule-making, program renewals, and oversight remains delayed or suspended (Foley Hoag LLP). The lapse includes waivers that had expanded access to remote care.
Telehealth Programs Roll Back
Medicare telehealth flexibilities expired on October 1, 2025, after temporary extensions through September ended without renewal. These policies had expanded access beyond rural areas and permitted home-based visits without geographic restrictions (American Telemedicine Association).
Without them, Medicare reverts to pre-pandemic rules:
Patients must live in rural areas.
Visits must take place at approved facilities (e.g., hospitals or clinics) (AAPA.org).
Providers who continue virtual visits outside those parameters risk losing reimbursement. Many have already canceled or converted telehealth appointments to in-person visits to avoid nonpayment (Health Journalism).
Patients are receiving notices that out-of-pocket costs could range from $221–$484 per visit without Medicare coverage (Stateline). Over 4 million Medicare beneficiaries used telehealth in the first half of 2025, making the rollback especially disruptive for older adults, rural residents, and patients with limited mobility (Stateline).
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics also face reimbursement losses because they can no longer bill for many remote services (Telehealth Resource Center).
Advocacy groups such as the American Telemedicine Association continue to push for temporary extensions, but congressional gridlock has blocked progress. Some providers are switching to direct-pay or insurance-independent models to maintain patient access (MyRxAccessPlus).
Hospital-at-Home Programs on Hold
Hospitals across several states, including New Jersey, have paused or scaled down hospital-at-home (HaH) programs after the expiration of CMS waivers on October 1, 2025 (Telehealth Resource Center). These programs have allowed hospitals to deliver acute-level care at home, reducing inpatient stays and improving patient outcomes.
The shutdown rendered these programs “collateral damage,” as many systems were unable to sustain operations without Medicare reimbursement. As of late 2024, 366 hospitals had participated in the HaH program, serving more than 31,000 patients, according to federal data (Stateline).
The impact is most significant for older and rural patients who rely on home-based recovery to avoid hospitalization. Lawmakers from both parties have expressed support for reinstating the waivers, but no legislative fix is in motion (STAT News).
Broader Fallout Across Healthcare
The shutdown compounds several other financial and operational challenges:
Medicaid DSH Cuts: An $8 billion reduction in disproportionate share hospital payments took effect October 1, straining safety-net hospitals (Forvis Mazars).
Medicare Low-Volume Adjustments: Tighter eligibility rules may cut payments to small rural hospitals (Forvis Mazars).
Rule-Making Delays: A prolonged shutdown could delay 2026 CMS payment updates and threaten funding for community health centers (NBC News).
End-of-Life Care: Access to hospice and palliative telehealth services has narrowed, reducing flexibility for patients and families (Compassion & Choices).
The longer the shutdown lasts, the deeper these disruptions will reach. Advocacy organizations are urging Congress to retroactively extend telehealth and HaH provisions once funding resumes (CMS.gov).
Bottom Line:
Healthcare executives should anticipate continued disruption in telehealth and hospital-at-home operations. Monitor CMS updates, review exposure to reimbursement risks, and prepare for operational adjustments until Congress restores funding and regulatory authority.