A partial government shutdown took effect Jan. 31 after Congress missed a midnight Jan. 30 deadline to pass a revised federal funding package — disrupting some health systems’ hospital-at-home programs as Medicare waivers tied to the service temporarily lapsed.
Although the Senate voted 71-29 late Jan. 30 to pass the revised package, the measure still must clear the House and be signed by President Donald Trump. The House is not scheduled to return until Feb. 2. The funding lapse affects large portions of the federal government.
The legislative package includes several healthcare provisions backed by hospital and provider groups, including an extension of pandemic-era telehealth flexibilities through 2027. It also extends the waiver for CMS’ hospital-at-home program through 2030.
Even brief gaps in waiver authority can force health systems to pause admissions or stop services to remain in compliance with federal rules.
ChristianaCare officials said they adjusted operations in advance of the shutdown to avoid interrupting care, Christine Donohue-Henry, MD, chief population health officer, told Becker’s
“In anticipation of the potential waiver expiration, we have stopped admitting patients with government payers,” she said. “Because of this preparation, we do not expect to transfer any current patients back to our brick-and-mortar hospitals should the waiver lapse again. Our program will continue to operate, serving patients whose payers remain supportive of hospital-at-home care.”
UMass Memorial Medical Center in Worcester, Mass., also paused new admissions. The health system stopped accepting new hospital-at-home patients Jan. 28, Constantinos “Taki” Michaelidis, MD, medical director of UMass Memorial Health’s Hospital at Home program, told Becker’s. The move came two months after the program reopened in November following the previous government shutdown that began Oct. 1.
Patients receiving care through UMass Memorial Health’s Hospital at Home program by Jan. 30 were transferred back to the brick-and-mortar hospital for ongoing acute care.
The waiver previously lapsed when the government shutdown began Oct. 1. Congress later revived the program as part of a stopgap spending bill passed Nov. 12, which extended the waiver through Jan. 30 and allowed retroactive payments. The legislation now under discussion includes an extension of the waiver through 2030.
Dr. Donohue-Henry said ChristianaCare will continue advocating with federal lawmakers and collaborating with health systems and national partners to ensure long-term stability for the program.
“ChristianaCare remains hopeful that a more permanent, five-year extension of the federal waiver will be enacted,” she said. “The evidence is clear: outcomes for Hospital Care at Home patients are excellent, and patient experience consistently exceeds traditional benchmarks.”
Dr. Michaelidis said uncertainty around the waiver creates operational whiplash for programs that can take weeks to ramp down and weeks to restart. He said he hopes Congress approves a longer extension and eventually makes the program permanent.
“Health systems across the country are going through a lot of flux for many reasons. And all of us — rural, urban, everywhere — are struggling with capacity to some degree,” he said. “We are not going to build our way out of this crisis. We simply will not build enough hospital beds to address the ‘silver tsunami’ coming down the pipeline.
“So if we believe that, we have to get more creative. We have to keep tools intact that allow health systems to care for patients in new ways. We can’t take tools away — we have to add tools, offer support, flexibility, and creativity.”
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