Telehealth, hospital-at-home get brief reprieve, but what happens next?

The longest ever government shutdown may be over, but the angst around the need for a stable, long-term solution to remote care access in the United States is still ongoing.  

Despite a temporary extension of COVID-era flexibilities until January 30, 2026, written into the continuing resolution that ended the shutdown, providers of telehealth and hospital-at-home services will be facing yet another cliff when this timer runs out, leaving them in the same uncomfortable position as they were just a few short months prior.  

Without assurances that telehealth and hospital-at-home benefits will be extended for a reasonable length of time after January, providers may need to once again pull back on vital services for Medicare beneficiaries who are unable to access care in person for a variety of needs across the entire spectrum of clinical acuity.  

What happened during the shutdown?

Medicare telehealth and hospital-at-home flexibilities were extended during the pandemic to ease access burdens for beneficiaries, and legislators have repeatedly kicked the can down the road since then in a series of short bursts, the latest of which was set to expire on September 30, 2025. So when the government shut down the next day, providers of these services were no longer able to bill for services delivered under the expired rules.   

This resulted in a scramble to cancel virtual care appointments and either discharge or move hospital-at-home patients into settings where they could receive a similar level of care.  

For both patients and health systems, the disruptions to care piled up swiftly. Hospitals reported longer waits for beds as patients previously treated at home were forced to move back into inpatient spaces, while beneficiaries with established remote relationships with their care teams complained of delays in access and interruptions in essential services.  

With providers unsure whether they would be retroactively reimbursed for care provided during the shutdown, however, there was little choice but to limit their losses.  

What happens now that the shutdown is over? 

The short-term continuing resolution that funds the government through the end of January 2026 also extends the pandemic-era telehealth flexibilities that were in place before the Congressional clash. This means that eligible providers can continue to offer a wider range of services to patients in their homes, with fewer restrictions on originating sites, the need for in-person visits, or the use of audio-only communications. 

And fortunately for those who continued to offer remote services during the lapse, CMS has announced that retroactive reimbursement will be available. “Telehealth flexibilities will apply retroactively as if there hadn’t been a temporary lapse in the application of the telehealth flexibilities through January 30, 2026,” the agency said in an FAQ, providing a measure of relief for clinicians. 

What happens next time the telehealth and hospital-at-home flexibilities expire?

That’s the big question that providers are urging Congress to figure out before history repeats itself.  

Since the pandemic, telehealth has become a highly valued and cost-effective option for patients, with about 15% of all Medicare fee-for-service beneficiaries and close to 30% of all clinicians taking part in virtual care in the first half of 2025 alone, according to a data brief from the Brown University Center for Advancing Health Policy Through Research. 

Telehealth visits declined by 24% in the first 17 days of October 2025 for fee-for-service Medicare beneficiaries and 13% for Medicare Advantage beneficiaries, the report states, showing the drastic and immediate impact of failing to extend the current flexibilities – or better yet, make them permanent in the next round of government funding legislation.  

It’s not as if a permanent solution lacks support.  Patients are on board.  Providers are desperate for a concrete answer.  And even lawmakers on both sides of the aisle recognize the potential improvements in costs and outcomes from creating certainty around these programs, with multiple bills introduced to solidify the remote care environment, even as recently as September 2025. 

And yet, no dice. For whatever reason, Congress has been unable to put the telehealth community out of its misery and provide an answer that would allow the industry to go all-in on innovation and access that could better support millions of patients, including those with socioeconomic barriers to care. 

It’s entirely possible that the end of January will be the beginning of yet another limited extension of these key flexibilities, keeping providers and patients in limbo for a few more months at a time. 

However, Congress has the opportunity to change this pattern once and for all – one way or the other.  Making a final decision on the state of the telehealth ecosystem will allow providers to move forward with a clear vision and make their investment decisions accordingly, enabling them to serve their patients to the best of their ability with whatever tools will be at their disposal for the long haul. 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at [email protected].