The federal government shut down at midnight on September 30 after Congress did not pass a funding bill or a short-term resolution for 2026. While Medicare and Medicaid continue as essential services and physician payments under these programs remain, several important health programs and flexibilities have expired. This change has created uncertainty for physician practices across the country.
One of the main changes is the expiration of most of Medicare’s pandemic-era telehealth waivers as of October 1. Congressional action is now needed to restore these waivers. As a result, Medicare telehealth coverage is again limited to rural areas, similar to the rules before the COVID-19 Public Health Emergency. Patients are no longer able to receive telehealth services from their homes except in certain cases.
The exceptions to this rule include treatment for mental health or behavioral health disorders (including substance use disorders), stroke evaluation and management, and monthly end-stage renal disease visits for home dialysis patients. For all other non-rural Medicare beneficiaries, telehealth visits are no longer available, and audio-only services have also ended. The Acute Hospital Care at Home program has also concluded.
The Centers for Medicare & Medicaid Services (CMS) advises clinicians who continue providing telehealth services that are not currently covered by Medicare to consider issuing Advance Beneficiary Notices of Noncoverage. These notices inform patients that Medicare may not reimburse them for those services. The American Medical Association points out one exception: “Physicians participating in certain Medicare Shared Savings Program Accountable Care Organizations may continue to provide and be paid for telehealth services under their program-specific waivers.”
Medicare claim processing will continue during the shutdown, even though the telehealth flexibilities have expired. CMS has clarified that physicians can still submit telehealth claims, but payments for these claims will be temporarily held while Congress considers whether to extend the waivers. If Congress restores the flexibilities, payments will likely be made retroactively, but there is no guarantee if Congress does not act.
The CMS newsletter suggests: “practitioners who choose to perform telehealth services that are not payable by Medicare on or after Oct. 1, 2025, may want to evaluate providing beneficiaries with an Advance Beneficiary Notice of Noncoverage.” Some physicians may decide instead to switch temporarily to in-person visits.
