The government shut down Tuesday night, making the home-based care industry’s concerns a reality.
The shutdown pushes the home health industry over a telehealth cliff, limiting its potential patient pool and adding administrative burden, and puts the Acute Hospital Care at Home (AHCAH) program on ice, which allowed hospitals to qualify for Medicare waivers to treat patients at home.
The shutdown also spells danger in several other facets of home-based care – including a potential delay to the anxiety-inducing CY 2026 home health final rule.
“Unfortunately, I think we’re going to really feel the pain on this one,” Alexis Apple, director of federal affairs for ATA Action, told Home Health Care News. “That continuity of care is now lost. … We have never been in this situation before, because [since] 2020, when all this was created, there hasn’t been a lapse in any of these flexibilities. Congress has continued the drumbeat. So now we’re trying to figure out, what do we even do?”
ATA Action is an advocacy organization that aims to push favorable telehealth policies into law.
Even the Centers for Medicare and Medicaid Services (CMS) seems caught off guard, Apple said. While the organization has issued some guidance on these provisions, nothing is set in stone or clear.
Hospital-at-home waiver expiration
One of the clearest pieces of guidance from CMS, Apple said, is that as of Oct. 1, all patients receiving hospital care at home must be discharged to the hospital immediately.
At-home hospital-level care programs operating outside of the waiver, including those under managed care arrangements or commercial contracts, can continue, Dr. Bruce Leff, professor of medicine at Johns Hopkins University School of Medicine, told HHCN.
As skilled home health agencies often partner with and provide services for hospital-at-home programs, hindrances to the hospital-at-home waiver will limit the opportunities for the home health industry.
“It obliterates a mechanism for [skilled home health agencies] to expand their repertoire and get involved in the broader health care delivery,” Leff said.
The government shutdown’s impact on hospital-at-home programs does not diminish overall support, according to Mass General Brigham.
“While there continues to be strong bipartisan support for the Acute Hospital Care at Home Waiver extension, it is unfortunate that the timing of its expiration was tied to the broader government funding debate,” a Mass General Brigham spokesperson told HHCN in a statement. “The future of healthcare is in the home and we are invested in our efforts to see this through.”
The healthcare system told HHCN that it has made preparations over the past year, allowing the organization to pivot its operations and provide advanced care at home for patients after a hospital stay during the waiver pause.
Stakeholders are afraid that the momentum behind the hospital-at-home program may now be lost, Leff said.
“If the shutdown goes on for any sort of extended period of time, those resources may not revert back to hospital-at-home,” Leff said. “[It would be] death by extensions.”
A series of short-term extensions has caused some hospital systems to balk at getting involved with hospital-at-home, fearing a wasted financial investment. The program’s success so far, which includes 10% of all U.S. hospital systems involved, represents a “yearning” for the model and highlights its importance, Leff said.
Telehealth flexibility paused
With the shutdown, Medicare telehealth flexibilities are no longer in place.
“Absent Congressional action, beginning Oct. 1, 2025, many of the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 Public Health Emergency will take effect again for services that are not behavioral and mental health services,” CMS said in a statement on Wednesday. “These include prohibition of many services provided to beneficiaries in their homes and outside of rural areas and hospice recertifications that require a face-to-face encounter.”
Prior to the shutdown, home health stakeholders expressed concerns that a lapse in critical Medicare telehealth flexibilities would delay patient visits and lead to increased administrative and billing challenges.
With the shutdown realized, providers and hospital systems are taking different approaches to telehealth. Some are essentially continuing as normal and plan to submit claims when the government is funded again, hoping for a retroactive reimbursement provision if the flexibility is extended. Others are on the opposite side of the spectrum, Apple said, and are ceasing services to avoid financial risk. Still others are taking a middle road, hoping for a quick end to the shutdown and the ability to resubmit claims.
“These flexibilities have been in place since 2020, during President Trump’s first administration, and this is the first time they have lapsed, creating widespread concern and disruption among providers and patients about the future of access to care,” read a Wednesday statement from ATA Action.
The shutdown’s extended impacts
Outside of the hospital-at-home waiver and telehealth flexibilities, home-based care providers can expect a list of impacts because of the government shutdown.
The shutdown could delay the release of the final rule, according to the National Alliance for Care at Home (the Alliance). The rule is normally expected to be announced by Nov. 1 and to go into effect on Jan. 1.
Home-based care providers may also experience delayed Medicare and Medicaid enrollments due to the shutdown, the Alliance said in a statement.
Medicare certification and recertification surveys could be impacted, and some may not take place, according to the Alliance. Complaint surveys could still occur, depending on severity and whether the state or CMS determines one is necessary for patient safety.
Other programs subject to annual appropriations, such as the Older Americans Act and the Social Services Block Grant, could also lapse or see reduced or paused service provision.
“Though these programs are substantially smaller in size and scope, they do provide valuable home care supports to individuals in the community, and an impact may be felt,” a statement from the Alliance read.
An end to the shutdown is not in sight.
“The house is technically in session, but they’re not around,” Apple said. “They got sent back home. They said they’re coming back next week, so nothing will be done over the next few days. The Senate is going to continue to do all these random votes. They’re not going to get enough to see anything through over the next few days. I think it’s at least going to be a week to 30 days.”
