The government was closed Tuesday night, bringing concerns to the home care industry a reality.
The shutdown will push the home health industry up on the telehealth cliff, limiting potential patient pools, adding administrative burdens and placing hospitals on ice (AHCAH) programs on ice.
The closure also spells out the risks in several other aspects of home care, including the potential delays in the CY 2026 home health final rule that induces anxiety.
“Unfortunately, I think we'll really feel pain from this,” Alexis Apple, director of federal affairs at ATA Action, told Home Health Care News. “That continuity of care is now lost. …We have never been in this situation before, because (since) in 2020, when this was all created, it hasn't expired in any of these flexibility. Congress continues to play drumbeats.
ATA Action is an advocacy organization aimed at promoting favorable telehealth policies into law.
Even the Centers for Medicare and Medicaid Services (CMS) appeared to have been caught off guard, Apple said. The organization has issued some guidance on these provisions, but nothing is set on stone.
Hospital exemption expires
According to Apple, one of the clearest guidance from the CMS is that as of October 1st, all patients receiving hospital care at home must be discharged from the hospital immediately.
Dr. Bruce Leff, a medical professor at Johns Hopkins University School of Medicine, told HHCN that he could continue to provide home hospital-level care programs that operate outside of exemptions, including managed care arrangements and commercial contracts.
As skilled home healthcare institutions often partner with and provide services with hospital home programs, the home exemption obstacles limit opportunities in the home healthcare industry.
“It erases the mechanisms that[skilled home healthcare institutions]can expand their repertoire and participate in a wider range of healthcare delivery,” Lev said.
According to popular general Brigham, the government said the impact of closures on hospital and home programs is not diminishing overall support.
“It's a shame that strong bipartisan support for acute hospital care during the extension of the home exemption has continued, but the timing of its expiration date has been linked to a wider government funding debate.” “The future of healthcare is at home and we are invested in efforts to see this through this.”
The Healthcare System told HHCN it has been preparing for the past year, allowing the organization to pivot its business to patients after admission during the exemption suspension, allowing them to provide advanced care at home.
Stakeholders fear that the momentum behind hospital and home programs could be lost, Lev said.
“If the shutdown continues for a long period of time, these resources may not be able to return to the hospital at home,” Lev said. “(It's) death due to extension.”
With a series of short-term dilations, some hospital systems are accusing by participating in hospitals at home, fearing discarded financial investments. The success of the program so far includes 10% of all US hospital systems involved, representing a “longing” for the model and underscored its importance, Leff said.
Telehealth flexibility has been suspended
With the shutdown, Medicare Telehealth is no longer flexible.
“Due to the absence of Congressional lawsuits that began on October 1, 2025, many of the statutory restrictions led to Medicare Telehealth Services prior to the Covid-19 public health emergency will be re-enabled for services that are not behavioural and mental health services,” CMS said in a statement Wednesday. “These include banning many services offered to beneficiaries outside of their home or rural areas, as well as recertifying hospices that require face-to-face encounters.”
Before the closure, home health stakeholders expressed concern that the lapse of critical Medicare telehealth flexibility would delay patient visits and lead to increased management and claims challenges.
Once shutdowns are achieved, providers and hospital systems are taking a variety of approaches to telehealth. Some have continued as normal in nature, and would like to see a retroactive refund clause if flexibility is extended, with plans to file claims when governments are funded again. Others are on the other side of the spectrum, Apple said, and they have stopped services to avoid financial risks. Additionally, others have taken the centre in hopes of a quick termination of their ability to shut down and resubmit claims.
“These flexibility has been in place since 2020 during President Trump's first administration. This is the first time they have expired and creates widespread concern and confusion among providers and patients about the future of access to care,” read ATA Action's statement on Wednesday.
The extended impact of shutdown
Outside of home exemptions and telehealth flexibility, home-based care providers can expect a list of impacts due to government closures.
According to the National Alliance for Home (The Alliance), shutdowns could delay the release of final rules. The rules are usually announced by November 1st and are expected to come into effect on January 1st.
The alliance said in a statement.
According to the alliance, Medicare accreditation and recertification investigations may be affected, and some may not be done. Complaint investigations may continue to occur depending on the severity level and whether or not the condition or CMS is deemed necessary for the patient's safety.
Other programs covered by the annual budget, such as the Elderly Act and the Social Services Block Grant, can also reduce or suspend service delivery.
“Though these programs are significantly smaller in size and scope, they provide valuable home care support to individuals in the community and may feel the impact,” the alliance statement read.
The end of the shutdown is invisible.
“The house is technically in session, but they're not around,” Apple said. “They were sent home. They said they'll be back next week so they won't do anything for the next few days. The Senate will continue to keep all these random votes. They won't see anything in the next few days. I think it'll be at least a week to 30 days.”
