At midnight on September 30, 2025, the federal government officially shut down following the failure of Congress to pass a 2026 funding bill or temporary resolution. While core services like Medicare and Medicaid payments will continue during the shutdown, the expiration of several key federal health programs—including Medicare’s telehealth waivers—is causing uncertainty for providers across the country.

If your practice provides telehealth services, these changes have immediate implications on how care is delivered and billed—particularly for Medicare patients.

📉 Telehealth Waivers Expire: What Changes Now?

As of October 1, Medicare’s temporary flexibilities granted during the public health emergency have expired. That means:

• Geographic Limitations Are Back

  Only patients in rural areas—designated as Health Professional Shortage Areas or outside Metropolitan Statistical Areas—are eligible for Medicare-covered telehealth visits.

• No More At-Home Telehealth for Urban Medicare Patients

  Traditional Medicare and Medicare Advantage patients outside rural areas can no longer receive telehealth from their homes.

• Audio-Only Visits No Longer Reimbursed

  CMS has stopped reimbursing for audio-only telehealth services, meaning providers must use full video visits or convert appointments to in-person care.

• Acute Hospital Care at Home Ends

  The Hospital at Home program, which allowed hospitals to deliver inpatient-level care in a patient’s home, has expired.

These changes apply to Medicare only. Medi-Cal services in California remain unchanged, thanks to state laws protecting telehealth parity.

💳 Billing and Payment Considerations

The Centers for Medicare & Medicaid Services (CMS) has stated that:

• Claims for eligible services can still be submitted, but…

• There will be a 10-day temporary payment hold on claims.

• Retroactive payment may be made if Congress later reinstates waivers.

• If Congress fails to act, those claims may not be paid at all.

Recommended action for practices:

• Consider converting scheduled Medicare telehealth visits to in-person appointments when possible.

• Use an Advance Beneficiary Notice (ABN) for telehealth visits that fall outside current eligibility.

• Track unpaid claims carefully and wait for congressional updates before escalating billing concerns.

📌 Medi-Cal Telehealth Services Remain Unchanged

For California providers, there’s good news: Medi-Cal telehealth billing and payments remain stable.

• California state law guarantees telehealth parity, including for audio-only visits.

• Medi-Cal claims are not affected by the federal waiver expirations or payment delays.

Practices treating a mixed patient population should segment patients accordingly to avoid claim denials.

🚨 Other Expired Health Programs

Several vital federal health programs expired with the shutdown, including:

• Community Health Center Funding

• National Health Service Corps

• Teaching Health Center Primary Care GME

• Special Diabetes Programs

• Medicare-Dependent Hospital Program

While many of these programs are expected to be reinstated, the temporary lapse could affect patient access and provider support across underserved communities.

🏛️ Congressional Negotiations Still Underway

Lawmakers from both parties support reinstating most of the expired programs, including the Medicare telehealth waivers. However, ongoing disagreements—especially around ACA premium tax credit extensions—have delayed progress.

Without a deal, up to 5 million Americans, including nearly 1 million Californians, may lose health coverage under the ACA.

✅ Key Takeaways for Providers

• Medicare telehealth waivers have ended; services are now limited by geography and setting.

• Audio-only visits are no longer billable under Medicare.

• Telehealth claims face a 10-day hold with payment not guaranteed until congressional action.

• Medi-Cal remains stable—telehealth continues as normal under California law.

• Providers should update workflows to reduce risk and consider collecting ABNs for non-covered telehealth visits.

🤝 How PractiCons Can Help

At PractiCons, we stay ahead of policy changes so your practice doesn’t have to. Whether you need:

• Help updating telehealth billing rules

• Support with scheduling and eligibility screening

• Revenue cycle consulting to prepare for delays or denials

• Legal-compliant workflows for ABN collection

…we’re here to guide you.

📞 Contact us today for expert guidance on navigating telehealth during the shutdown and ensuring your practice remains profitable and compliant.