The federal government entered a shutdown at midnight on September 30, 2025, after Congress did not pass a funding bill or a short-term resolution for 2026. While Medicare and Medicaid payments to physicians continue, the expiration of key health programs and flexibilities has introduced new challenges for medical practices across the country.
One significant change is the rollback of most Medicare telehealth waivers that were put in place during the COVID-19 pandemic. As of October 1, Medicare telehealth coverage is now restricted to rural areas, similar to the policy before the pandemic. Patients are no longer able to receive telehealth services from their homes except in certain cases.
The exceptions include treatment for mental health or behavioral health disorders, including substance use disorders, stroke evaluation and management, and monthly visits for end-stage renal disease patients on home dialysis. For all other non-rural Medicare beneficiaries, telehealth visits are no longer covered, and the option for audio-only services has also ended. The Acute Hospital Care at Home program has also concluded.
The Centers for Medicare & Medicaid Services (CMS) advises clinicians who continue to provide telehealth services that are no longer covered by Medicare to consider issuing Advance Beneficiary Notices of Noncoverage. This notice informs patients that Medicare may not reimburse these services. The American Medical Association points out that physicians in certain Medicare Shared Savings Program Accountable Care Organizations can still provide and receive payment for telehealth services under specific waivers.
Despite these changes, Medicare claim processing remains active during the shutdown. CMS has stated that telehealth claims can still be submitted, but payments will be temporarily held while Congress decides whether to extend the waivers. If Congress restores the telehealth flexibilities, payments are expected to be made retroactively. However, there is no assurance of payment 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 to shift back to in-person visits due to this uncertainty.
