Introduction
Medicare beneficiaries across the United States face a potential healthcare crisis as two critical virtual care programs hang in the balance. The Medicare telehealth waivers and Acute Hospital at Home (AcHaH) programs, lifelines established during the pandemic, are set to expire on October 1, 2025, unless Congress passes emergency funding legislation. This impending deadline creates uncertainty for millions of patients and healthcare providers nationwide who have come to rely on these expanded telehealth services.
The federal government shutdown threat looms large, with political gridlock in Washington putting essential healthcare services at risk. Healthcare systems and virtual care companies now face an impossible choice: continue providing services without payment guarantees or cut off access to vulnerable patient populations.
What Programs Are at Risk?
Medicare Telehealth Waivers
The pandemic-era telehealth flexibilities have dramatically transformed healthcare delivery over the past five-and-a-half years. These expanded authorities include several game-changing provisions that benefit both patients and providers:
- Home-based telehealth visits: Patients can receive care from the comfort of their homes rather than traveling to designated facilities
- Geographic expansion: Telehealth services are now available in both rural and urban areas, eliminating previous location restrictions
- Provider diversity: An expanded roster of healthcare professionals, including physical therapists, occupational therapists, and other specialists, can now deliver telehealth services
Acute Hospital at Home Program
The Acute Hospital at Home waiver allows hospitals to provide hospital-level care in patients’ homes. As of September 22, 2025, there are 419 hospital-at-home programs operated by 147 health systems across 39 states. This innovative approach has improved patient outcomes while reducing healthcare costs, making it a win-win for Medicare and beneficiaries alike.
The Political Battle Behind Healthcare Access
Democrats vs. Republicans Funding Standoff
Healthcare has become a major sticking point in Congress’s attempt to pass a short-term government funding bill through November 21. Democrats are withholding votes until Republicans agree to extend expiring subsidies for Affordable Care Act tax credits. This political brinkmanship puts essential healthcare programs in jeopardy.
The minority party risks triggering a government shutdown if they don’t vote with Republicans to pass a continuing resolution. However, their leverage lies in demanding protections for healthcare programs that millions of Americans depend upon daily.
A Pattern of Last-Minute Extensions
This isn’t the first time these programs have faced the chopping block. The telehealth flexibilities have been extended multiple times when facing deadlines:
- December 2024: Three-month extension alongside government funding
- March 31, 2025: Six-month extension through September 30
Congress and CMS have consistently demonstrated they value these programs, yet permanent solutions remain elusive due to broader political conflicts.
Impact on Healthcare Providers
Navigating Legal and Financial Uncertainty
Rachel Stauffer, principal at McDermott+, explains the impossible position facing healthcare stakeholders: “As of October 1, those flexibilities go away. Policymakers across the board clearly don’t want the telehealth flexibilities to end. It’s just a matter of these are tied to this larger CR battle. I think stakeholders are in a really tough spot here, because they want to clearly abide by the law, but it’s a little murky here.”
Without clear guidance from CMS and without an extension, providers face legal and financial risks if they continue offering services that may not be reimbursed.
CMS Guidance and Hospital-at-Home Concerns
Unprecedented Direction from CMS
For the first time, CMS has issued explicit guidance directing hospitals to make difficult decisions about their hospital-at-home patients. The guidance states: “For all hospitals with active AHCAH waivers, all inpatients must be discharged or returned to the hospital on September 30, 2025, in the absence of Congressional action to extend the initiative.”
This directive forces healthcare systems to either:
- Transfer patients back to brick-and-mortar facilities
- Discharge patients prematurely
- Continue care without reimbursement guarantees
Retroactive Billing Questions
The Alliance for Connected Care has urgently requested CMS guidance on retroactive billing and assurances that providers won’t face penalties for continuing services during a shutdown. Executive Director Chris Adamec stated: “CMS could ease related compliance burdens for providers if there is a temporary authority change. An announcement of this nature would provide much-needed stability to providers and patients alike.”
Financial Dilemmas for Healthcare Systems
The Resource Divide
Kyle Zebley, executive director of the American Telemedicine Association’s advocacy arm (ATA Action), highlights the disparities: “There are different health systems and provider groups that are going different directions. There are those that do not have the financial ability to last all that long and run the risk of not getting reimbursed.”
Healthcare systems fall into two camps:
Financially Constrained Providers: These organizations cannot afford to operate without guaranteed reimbursement and will cut off access to telehealth programs immediately.
Financially Stable Providers: Larger health systems with stronger financial positions may “roll the dice” and continue services, hoping Congress acts before payments become unsustainable.
The Stakes for Patient Access
This financial divide creates healthcare inequities. Patients served by smaller, less financially stable providers will lose access first, while those connected to major health systems may maintain services longer. This outcome contradicts the equity goals that telehealth expansion was meant to achieve.
Legislative Efforts and Future Outlook
Bipartisan Support Without Action
Despite widespread bipartisan and bicameral support, Congress has failed to pass permanent legislation or meaningful long-term extensions. Several bills are pending:
The CONNECT for Health Act: Introduced in April by Senator Brian Schatz (D-Hawaii), this legislation would make telehealth flexibilities permanent and has garnered 63 co-sponsors.
Telehealth Modernization Act of 2025: Rep. Buddy Carter (R-Ga.) and Democrat Debbie Dingell (D-Mich.) introduced a two-year extension bill in early September.
Hospital-at-Home Extension: Legislative proposals exist to extend the program for five years, recently passed out of the Ways & Means committee, though timing for House floor consideration remains uncertain.
The Frustration of Short-Term Thinking
Stauffer captures the frustration among healthcare advocates: “They’re not giving themselves enough time. These extensions are two, three months, and then they have to deal with another extension before they can even really consider permanent policy.”
Conclusion
The potential expiration of Medicare telehealth waivers and the Acute Hospital at Home program represents more than a political failure—it threatens healthcare access for millions of Americans. While policymakers universally support these programs, their inability to separate healthcare from broader appropriations battles leaves patients and providers in limbo.
Healthcare stakeholders continue lobbying for extensions and permanent solutions, but the October 1 deadline rapidly approaches. The outcome will determine whether innovative, patient-centered care models survive or become casualties of political dysfunction.
Discover the latest Provider news updates with a single click. Follow DistilINFO HospitalIT and stay ahead with updates. Join our community today!
Leave a Reply