What a Federal Government “Shutdown” Means for PAs and Their Patients

Essential health programs remain largely in place

October 1, 2025

With Congress unable to reach an agreement before the midnight deadline, the federal government entered a shutdown this morning.

The American Academy of Physician Associates (AAPA) urges Congress to work together to enact legislation to fund the government and continue critical healthcare programs. We are hopeful that this will be a brief shutdown with a limited negative impact on PAs and their patients.

Below is a high-level overview of what continues, what slows, and what may be at stake for PAs and their patients.

What Continues
A considerable amount of spending on federal healthcare programs is “non-discretionary,” meaning it is funded outside of the annual appropriations process and therefore is less affected by a shutdown. As a result, many of the most critical healthcare programs continue to operate even during a lapse.

• Medicare operations remain in place. Beneficiaries will still receive coverage, providers can continue submitting claims, and payments to providers are expected to continue. However, some support services for providers and beneficiaries may be delayed if they rely on furloughed staff.
• Medicaid and CHIP funding continue. Because Congress has already provided advance appropriations for the first quarter of FY 2026, states are expected to continue receiving funding for Medicaid and CHIP during the shutdown.
• Veterans Health Administration (VHA) services are protected. The VHA has advance appropriations in place and is not expecting PAs to be impacted. As the largest employer of PAs in the country, VA medical centers and clinics are expected to continue operations during the shutdown, according to VA’s contingency planning guidance.
• Essential HHS functions are staffed. Activities that protect life, property, and safety should continue. Such functions include public health emergency response, infectious disease monitoring, and direct patient care at federally funded facilities.
• Certain oversight and innovation work continues. Efforts related to fraud prevention and enforcement, as well as some aspects of CMS’s Center for Medicare & Medicaid Innovation (CMMI), are not tied to annual appropriations, so they remain active.

What Is Expected to Slow or Pause
While core healthcare programs continue, the shutdown still slows much of the federal “infrastructure” that supports patients, providers, and the broader health system. For example, provider and beneficiary support services such as call centers and help desks are scaling back, which means slower responses to billing questions, appeals, or eligibility inquiries. Routine inspections of facilities, nursing homes, and labs are also delayed, with only those tied to urgent threats to health and safety moving forward.

Policy development and regulatory work will largely pause, putting on hold new rules, guidance, and initiatives that can shape how care is delivered. Outreach and education efforts — from provider training to beneficiary information campaigns — are also suspended until funding is restored. Oversight of contractors that process claims or conduct audits is reduced, which can create backlogs and slow the system down further.

Public health agencies such as CDC and NIH are operating with significantly reduced staff. That means research projects, disease surveillance, grant administration, and the release of new health data may be delayed. While patients may not notice these effects immediately, the longer the shutdown continues, the greater the impacts on research progress, program oversight, and the broader health system that supports everyday care.

The shutdown also carries implications for PAs serving in the military. The Army is the second-largest federal employer of PAs, just behind the VA, with many serving in uniformed and civilian roles. Military service members will receive their October 1 paychecks as scheduled, since those funds cover the period before the shutdown. However, if the shutdown extends beyond two weeks, future paydays could be disrupted.

Telehealth and Other Flexibilities Expire
In addition to the shutdown, patients and PAs now face the expiration of several critical Medicare flexibilities. Because Congress did not act before the September 30 deadline, the temporary provisions that had expanded access to telehealth and hospital-at-home care expired. As a result, beginning today, October 1, 2025, Medicare beneficiaries receiving telehealth services must once again be in a rural area and in an approved medical facility for most services.

During the COVID-19 pandemic, Congress temporarily lifted restrictions on where patients covered by fee-for-service Medicare could receive telehealth. These waivers allowed a patient’s home to count as an “originating site” for a telehealth visit and removed the requirement that a patient be located in a rural area.

Lawmakers extended these flexibilities several times. Under section 4113 of the Consolidated Appropriations Act of 2023, the statutory restrictions on the geographic location and site of service were suspended through the end of 2024. Telehealth flexibilities were extended a second time by legislation through September 2025.

With the expiration of these site flexibilities, the allowance for a patient to receive care in their home is now limited to patients receiving behavioral services or a narrow set of other services exempt from geographic restrictions.

Important Note: These policy changes only apply to Original Medicare. Medicare Advantage, Medicaid, Medicaid Managed Care, and commercial plans may have different policies.

Other statutorily granted telehealth waivers that expired on October 1 include:

• Authorization for providers at Federally Qualified Health Centers and Rural Health Clinics to continue to provide telehealth services;
• Authorization for telehealth to be used for the required face-to-face encounters before recertification for hospice care; and
• Delayed reimplementation of requirements that a patient receiving behavioral health services via telehealth must first have an in-person visit with their provider, and periodically after.

Because the expiration of these flexibilities coincides with the beginning of a government shutdown, AAPA expects a lapse in these flexibilities, at least temporarily. We are hopeful that, due to strong bipartisan interest in perpetuating these flexibilities, legislation will eventually be passed to further extend their implementation. However, until such legislative authority is reestablished by Congress, PAs should check with their employer to determine how their practices will handle previously scheduled telehealth visits for categories of patients that are no longer covered that were to take place after October 1.

AAPA’s Role
AAPA’s Federal Advocacy and Reimbursement Advocacy staff will continue to closely monitor the situation and advocate for PAs and the patients they serve. We are pressing for Congress to include provisions to maintain telehealth and other critical flexibilities in any agreement to reopen the federal government, as well as to retroactively restore coverage for telehealth services.

The nature of any government shutdown, and its impact, depends on how long it lasts and the actions Congress takes to resolve it. For PAs and patients, the effects may be limited in some areas and more disruptive in others. To help us capture the impact of a shutdown on the profession, we are asking PAs to share their experiences. These stories allow AAPA to better understand and highlight the challenges PAs face during a government shutdown and to use those insights in our advocacy efforts. If you, your practice, or your patients have been impacted and you would like to share your experience in general terms, please do so here.

See https://www.hhs.gov/about/budget/fy-2025-cms-contingency-staffing-plan/index.html for additional information.

For additional questions you may have, please feel free to contact AAPA’s Advocacy Division at [email protected]. 

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