The federal government shutdown will stretch into a second week after Senate Democrats and Republicans failed to agree on competing funding bills Oct. 3, according to The Hill.
The standoff is already disrupting federal operations — including at CMS — and could carry significant knock-on effects for providers and patients if prolonged.
Four things to know:
1. Senate deadlock deepens. On Oct. 3, senators rejected both a Republican-led stopgap measure and a Democratic proposal that tied government funding to healthcare priorities such as extending ACA premium tax subsidies. Lawmakers are out of session for the weekend and are set to return Oct. 6, when Senate leaders are expected to force a fifth vote on a House-passed measure to fund the government through Nov. 21, according to Politico. Speaker Mike Johnson said the House will not reconvene next week, delaying any votes until at least Oct. 14, NBC News reported.
Democrats are pushing to extend ACA premium tax credits before Nov. 1, when open enrollment begins. Republicans want to negotiate broader spending issues through regular appropriations rather than attaching healthcare provisions to short-term bills, according to The Hill.
2. Shutdown puts telehealth and hospital-at-home programs at risk. The shutdown has triggered lapses in certain waivers: CMS’ hospital-at-home waiver expired Oct. 1, forcing some providers into a frenzy, rushing to bring patients back into brick-and-mortar facilities. Medicare coverage for telehealth visits was extended multiple times over the past five years, but lapses without the passage of a spending bill.
During the shutdown, CMS has placed a temporary hold of up to 10 business days on certain Medicare claims, delaying payments but not blocking submissions, according to a news release shared with Becker’s. Because Congress did not act before Oct. 1, many pre-pandemic telehealth restrictions have returned: Medicare will no longer reimburse most telehealth services delivered outside rural areas or in patients’ homes, except for behavioral health. CMS said providers may need to issue advance beneficiary notices if offering non-covered services. An exception remains for clinicians in Medicare Shared Savings Program ACOs, who can continue to bill for covered telehealth regardless of geographic limits.
3. HHS to furlough nearly half its workforce. HHS said it will furlough about 41% of its 79,717 employees. While critical functions such as Medicare and Medicaid payments, disease outbreak monitoring, and FDA food safety oversight will continue, other activities are halted. This includes oversight of research contracts and grants, some CMS contractor monitoring, and most NIH patient admissions. The CDC also warned that communication to the public could be hampered.
4. Federal workforce faces unprecedented job losses. In a departure from previous shutdowns, the Trump administration has framed the funding lapse as an opportunity to permanently downsize federal agencies, according to The Hill. The Office of Management and Budget directed agencies to prepare layoff plans targeting programs inconsistent with the administration’s priorities.
Unions have filed lawsuits challenging the move, calling it an “unlawful abuse of power” designed to punish workers and pressure Congress. If carried out, the plan could create legal battles with ripple effects across the healthcare system.
