Article
What is in the package
H.R. 7148 combines the fiscal 2026 Labor-HHS-Education appropriations bill with other spending measures and a set of Medicare and Medicaid extenders. For hospitals, the most material items are:
- Medicaid DSH relief. Two years of scheduled disproportionate share hospital reductions would be eliminated, pushing the cuts out to fiscal 2028.
- Telehealth. Medicare telehealth flexibilities would run through Dec. 31, 2027, a two-year extension instead of the short patches of recent cycles.
- Hospital at home. The Acute Hospital Care at Home waiver would be extended five years, through Sept. 30, 2030.
- Rural payment programs. The Medicare-dependent hospital program and the enhanced low-volume adjustment would get one-year extensions.
- Workforce and academic items. Teaching Health Center GME funding would run through fiscal 2029, Dr. Lorna Breen Act programs through 2030, and NIH would receive $47.2 billion, $415 million above the prior year.
The package does not revive the enhanced marketplace subsidies that lapsed at the end of 2025.
Why the multi-year terms matter
Short extensions have made it hard to justify investment in virtual care and home-based acute programs. A two-year telehealth window and a five-year hospital-at-home horizon change the math. Systems that paused hospital-at-home expansion because of waiver risk can now build business cases on a realistic payback period, and telehealth staffing and platform contracts can be signed with more confidence.
DSH relief is the largest near-term dollar item for safety-net hospitals, which have operated for years with these cuts perpetually looming. A delay to fiscal 2028 does not remove the cliff, but it moves it beyond the next budget cycle.
The Senate risk
Current federal funding runs through Jan. 30. The Senate returns next week with only a few days to clear this package and the remaining spending bills. If it stalls, extender dates could lapse, and claims processing and program operations could be disrupted by another shutdown.
Finance and government relations teams should prepare two scenarios for February: one where these provisions become law and one where they lapse briefly and are restored later. In the second case, decide in advance how to handle telehealth scheduling, hospital-at-home admissions and rural add-on payments during any gap.
Archive entry for Jan 23, 2026, added Nov. 11, 2026.