In the midst of the noise, clarity should reign.
We are now on Day 9 of the federal government shutdown, and its impact on healthcare operations and reimbursement is growing by the day.
At the center of this stalemate is a debate over insurance subsidies that could affect millions of Americans. If Congress fails to act, those subsidies will expire at the end of this year, causing ACA marketplace premiums to more than double for many families. Learn more here.
However, while national attention focuses on politics, three critical healthcare policies tied to the current budget resolution have quietly expired, carrying significant operational and financial implications for hospitals, health systems, and EMS providers alike.
| MORE:Government shutdown: What it means for ambulance services
Three key healthcare policies now in limbo
All three policies expired on September 30, 2025.
In response, CMS has issued guidance to all Medicare Administrative Contractors (MACs) to implement a temporary claims hold of up to 10 business days. This hold is intended to prevent claim reprocessing if the government shutdown ends soon and the payment extensions are reinstated.
If Congress does not act, however, ambulance claims will begin processing without the extender payments, resulting in reduced reimbursement for providers already operating on tight margins.
The current state of play
As of today, there is no consensus in the Senate on advancing the House’s CR, which would both fund the government through November 21 and extend the telehealth, hospital-at-home, and ambulance provisions.
Without that action, the shutdown will likely persist in the short term.
What healthcare providers should do to prepare
Over the past several days, many have reached out asking how to prepare operationally and financially if the shutdown continues. Below are several key considerations for healthcare finance leaders and revenue cycle teams:
1. Manage claims strategically
I continue to recommend holding all Medicare FFS claims until at least Oct. 15, 2025, for dates of service beginning October 1. If the shutdown persists, the administrative burden of reprocessing claims once the government reopens could be extensive.
2. Prioritize cash flow continuity
Cash flow is essential to sustain patient care. Ambulance services are already operating on razor thin margins across nonprofit, for profit, and governmental providers. If you are currently submitting Medicare claims or any claims that are tied to the current Medicare prevailing fee schedule, begin developing a Plan B in the event the ambulance extenders are not addressed when a compromise occurs to fund the government. Plan B should account for the possibility that claims will process without the 2% urban, 3% rural, and 22.6% super rural add ons until Congress acts.
3. Strengthen back office readiness
Step 1: Identify all payers that benchmark reimbursement against the Medicare fee schedule, such as Medicare Advantage, Tricare or commercial payers where the current, prevailing Medicare fee schedule is used as a percentage of payment.
Step 2: Build workflows to manage claim reprocessing if rates change after the shutdown.
These foundational steps can prevent delays, misapplied payments and revenue leakage if reimbursement changes after resolution.
Navigating the uncertainty
Congress appears to be at a stalemate, and unless there is an unexpected breakthrough, the shutdown may continue in the short term. For healthcare organizations, this means planning for financial resilience now, rather than waiting for clarity later.
As Maya Angelou said, “Hope for the best, prepare for the worst, and be surprised by anything in between.”
At Solutions Group Services, our motto remains clear: We are solutions givers, not crisis managers.
If your organization needs guidance in developing a financial contingency plan, identifying payer exposure, or managing claim strategies during the shutdown, we are here to help.
