As the federal government shutdown enters its fourth week, various health programs such as hospital-at-home services, telehealth and ambulance services, and open enrollment are either seeing direct impacts or are facing the potential for disruptions.

The federal government entered a partial shutdown on October 1 after Congress failed to pass a continuing resolution (CR) to fund agencies into the new fiscal year. The deadlock centers on health care policy — specifically whether to extend enhanced Affordable Care Act (ACA) premium tax credits that are set to expire at the end of the year.

Democrats are demanding the subsidies be renewed as part of any funding package, while Republicans argue the issue should be debated separately. The Senate has rejected the House-passed CR multiple times, and the stalemate has now entered its fourth week.

Although essential services and mandatory programs such as Medicare, Medicaid, and Veterans Health continue to operate, a growing number of federal health care functions are being curtailed or delayed. For hospital and other health care entities, here’s a review of impacts of the shutdown so far and an outlook going forward should the shutdown continue.

Federal Health Care Operations

The White House has taken an unusually aggressive stance during this shutdown by authorizing mass "reduction in force" (RIF) layoffs of federal employees rather than typical furloughs. More than 4,000 workers — including Centers for Disease Control and Prevention (CDC) and health data personnel — received termination notices before a federal judge intervened to temporarily block further firings.

Administrative activities such as claims processing, data reporting, and grant administration have slowed considerably. While entitlement programs remain funded, the disruption is being felt across programs that depend on ongoing appropriations or statutory renewals.

Disruptions to Key Health Programs

Hospital-at-Home Program: The Medicare-funded "hospital-at-home" initiative, which allows hospitals to treat patients at home, has been severely disrupted. Without renewed waivers or funding, hospitals have paused or scaled back these services, potentially pushing patients back into inpatient settings and straining capacity.

Telehealth and Ambulance Services: The expiration of temporary telehealth flexibilities has created reimbursement uncertainty, especially in rural and underserved areas. Ambulance providers and emergency medical services warn that delayed payments could affect response capacity.

Insurance Marketplaces and ACA Subsidies: The shutdown has deepened uncertainty in the ACA marketplaces ahead of open enrollment on November 1. Without congressional action to extend the enhanced premium subsidies, millions could face significant premium increases or coverage losses starting in January. Insurers are already preparing rate and plan adjustments amid the uncertainty.

Public Health Communication and Surveillance: The CDC’s outbreak tracking, guidance publication, and weekly morbidity reports have been interrupted by staffing losses, limiting the agency’s ability to provide timely health data.

Medicare and Medicaid

Core health entitlements remain operational through mandatory appropriations. Medicare payments and claims processing continue, though beneficiaries may experience delays reaching call centers during the open enrollment period (October 15 – December 7).

Medicaid continues under its advance appropriations for the first quarter of fiscal year 2026, but prolonged funding uncertainty could create administrative challenges for state agencies and managed care providers.

What to Expect if the Shutdown Continues

If the shutdown extends through late October:

• ACA marketplace open enrollment will begin amid administrative disruption.
   
• Hospitals may see growing operational strain from paused home-based care programs.
   
• The Senate Appropriations Committee is drafting an alternate stopgap bill that would include a one-year ACA subsidy extension — potentially setting up another funding showdown before Halloween.

Comparison to Prior Shutdowns

Feature	2025 Shutdown	2018-19 Shutdown	2013 Shutdown
Duration (as of mid-October)	20+ days and ongoing	35 days	16 days
Primary Issue	ACA premium tax credits; workforce cuts	Border wall funding	"Defund Obamacare"
Health Care Impact	Telehealth and Hospital-at-Home halted; ACA subsidies at risk	Limited	Major disruption to ACA rollout
Agency Operations	Deep health policy staff cuts; RIF orders partially blocked	Grant delays	NIH, CDC, CMS research halted
Economic Cost (est.)	≈ $15 billion/week	≈ $11 billion total	≈ $2 billion total

Click here to read our prior alert on the government shutdown. 

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