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Government shutdown: What it means for ambulance services

Medicare will pay claims without add-ons if a funding deal takes more than two weeks

Congress Shutdown

A partisan standoff over health care and spending is threatening to trigger the first U.S. government shutdown in almost seven years, at the Capitol in Washington, Tuesday, Sept. 30, 2025.

J. Scott Applewhite/AP

MECHANICSBURG, Pa. — With Congress missing the midnight deadline to pass a new spending bill, the federal government shut down at 12:01 a.m. today. Lawmakers have not indicated when a deal might be reached and key provisions for ground ambulance providers expired along with the funding resolution.

The PWW Advisory Group reported that the 2% urban, 3% rural and 22.6% super-rural Medicare add-on payments for ground ambulance services lapsed on Sept. 30. Industry groups are urging Congress to include an extension in any stopgap or full-year appropriations package.

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Medicare payments and activities

Medicare operations will largely continue during the shutdown:

  1. Claims and payments: Medicare Administrative Contractors are expected to process and pay ambulance claims on their normal schedules.
  2. Administrative tasks: Enrollment actions, including revalidations and some audit work may slow or pause, particularly if the shutdown stretches on.

Ambulance add-ons

If Congress passes a funding bill within two weeks:

  • Medicare Administrative Contractors (MACs) hold claims for 14 days before paying, so they should have time to apply the renewed add-ons and payment levels would remain unchanged.

If Congress takes longer than two weeks:

  • MACs will begin paying claims dated Oct. 1 and later without the add-ons.
  • Should lawmakers later restore the add-ons — potentially retroactive to Oct. 1 — MACs would reprocess those claims and issue the additional payments, as they have in previous lapses.

If the spending bill omits the ambulance add-ons, Medicare will stop paying the 2% urban, 3% rural and 22.6% super-rural boosts for trips on or after Oct. 1; only new legislation could restore them. Medicare’s telehealth flexibilities and hospital-at-home waivers also expired and need congressional renewal to continue.

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Bill Carey is the associate editor for FireRescue1.com and EMS1.com. A former Maryland volunteer firefighter, sergeant, and lieutenant, Bill has written for several fire service publications and platforms. His work on firefighter behavioral health garnered a 2014 Neal Award nomination. His ongoing research and writings about line-of-duty death data is frequently cited in articles, presentations, and trainings. Have a news tip? He can be reached at news@lexipol.com.