Article
Where things stand
The short-term spending law signed Nov. 12 ended the fall government shutdown and restored the Medicare telehealth and hospital-at-home waivers that had lapsed on Sept. 30. The restoration applied back to Oct. 1, so claims CMS had held for that period could be reprocessed. But the waivers are tied to the same law, which expires Jan. 30.
If Congress does not act by then, Medicare falls back to pre-pandemic rules. Visits from a patient’s home outside behavioral health would again face geographic and originating-site limits, audio-only coverage would narrow and in-person requirements for some mental health services would return. Several bipartisan bills would make the flexibilities permanent, but none has passed.
Why hospital at home is most exposed
The stakes are highest for acute care at home. Federal data cited in November showed 147 health systems with 419 hospitals in 39 states approved for the waiver. Without it, these programs cannot bill Medicare for inpatient-level care delivered at home, and patients would need to be returned to a facility. The American Hospital Association has said some systems already delayed launching programs because of repeated funding uncertainty.
The fall lapse lasted more than a month and showed what an interruption costs: held claims, paused admissions, staff reassigned and patients confused about whether visits were covered.
What to do in the next three weeks
- Write a lapse playbook now. Decide in advance when to stop new hospital-at-home admissions, how to move current patients and how to redeploy home-based staff.
- Sort telehealth visits by risk. Identify which scheduled Medicare visits after Jan. 30 depend on the waivers and which, such as most behavioral health, would continue.
- Prepare scripts and notices. Patients and referring physicians need clear, early guidance on whether to convert visits to in-person care.
- Plan for held claims. Track waiver-dependent services separately so they can be released quickly if Congress acts retroactively again.
- Engage your delegation. Give members of Congress concrete local data on patients served at home and avoided admissions.
Boards should treat both programs as strategic assets exposed to short-term political risk and ask whether growth plans assume an extension that has not been enacted.
Archive entry for Jan 7, 2026, added Nov. 11, 2026.