Government Shutdown Creates Uncertainty and Disruption for Home-Based Care: Hospital-at-Home, Telehealth, and Beyond
The ongoing government shutdown is casting a long shadow over the rapidly expanding home-based care sector, creating notable uncertainty for providers, hospitals, and – most importantly – patients. From jeopardizing the momentum of innovative programs like Hospital-at-home to disrupting established telehealth services and delaying crucial regulatory updates, the impacts are far-reaching and demand careful attention. This article provides a extensive overview of the current situation, outlining the challenges and potential pathways forward for the industry.
The Looming Threat to Hospital-at-Home Expansion
Hospital-at-Home (HaH), a model gaining traction for its ability to deliver acute-level care in the comfort of patients’ homes, is facing a critical juncture.The program’s growth has been fueled by waivers granted during the COVID-19 Public Health emergency (PHE). However, the expiration of these waivers, coupled with the shutdown’s impact on CMS decision-making, is causing hesitation among hospital systems.
Recent reports indicate that some systems are “balking” at further investment in HaH, fearing a wasted financial commitment if the necessary regulatory support isn’t sustained. Despite this concern, the program’s current success – with approximately 10% of U.S. hospitals already participating – underscores a strong “yearning” for this patient-centered approach. Dr. Bruce Leff, a leading expert in the field, emphasizes the importance of HaH, highlighting its potential to improve patient outcomes and reduce healthcare costs. The future of HaH now hinges on swift Congressional action to solidify its regulatory framework.
Telehealth Flexibilities Paused: A Step Backwards for Access to Care
Perhaps the most immediate and widespread impact of the shutdown is the lapse of medicare telehealth flexibilities. These provisions, initially implemented during the PHE, allowed for broader access to virtual care, including services delivered in patients’ homes and outside of rural areas.
As of October 1, 2025, many pre-PHE restrictions have been reinstated for services not related to behavioral and mental health. This means limitations on providing telehealth to beneficiaries in their homes and requirements for in-person encounters for certain services, like hospice recertifications.
The sudden removal of these flexibilities has created a chaotic landscape for providers. Some are continuing to provide telehealth services and plan to submit claims retroactively, hoping for reimbursement if the flexibilities are reinstated. Others, prioritizing financial stability, have temporarily ceased telehealth offerings. A middle ground approach involves pausing services with the expectation of a swift resolution to the shutdown.
The American Telemedicine Association (ATA) Action has voiced strong concerns, noting that these flexibilities have been in place since 2020 and their lapse represents a significant disruption to patient access. The uncertainty is especially troubling given the proven benefits of telehealth in improving care delivery and addressing healthcare disparities.
Beyond HaH and Telehealth: A Cascade of Impacts
The shutdown’s repercussions extend beyond Hospital-at-Home and telehealth, impacting a wide range of home-based care operations:
* Delayed Rulemaking: The release of the final rule governing home-based care, typically expected by November 1st with implementation on January 1st, is likely to be delayed. This rule is critical for establishing clear standards and guidelines for the industry.
* Enrollment Delays: Medicare and Medicaid enrollment processes for home-based care providers are facing potential delays,hindering the ability of new agencies to serve patients.
* Survey Disruptions: Medicare certification and recertification surveys, essential for ensuring quality of care, might potentially be postponed. While complaint surveys related to patient safety will likely continue, the overall disruption to the survey process is concerning.
* Impact on Vital programs: Funding for programs like the Older Americans Act and the Social Services Block grant, which provide crucial support services to seniors and individuals with disabilities, coudl be reduced or paused, impacting access to essential home care resources.
the National Alliance for care at Home (the Alliance) has been actively communicating these potential impacts to its members, emphasizing the need for proactive planning and advocacy.
What’s the Timeline for Resolution?
Regrettably, a clear end to the shutdown remains elusive. Sources indicate that while the House of Representatives is technically in session, legislative progress is stalled. The Senate is continuing to hold votes, but a breakthrough appears unlikely in the immediate future.
“I think it’s at least going to be a week to 30 days,” estimates one industry insider,highlighting the prolonged uncertainty facing