September 30, 2025
McKnight's Long-Term Care News
Long-term care leaders have become used to budget deals that go into overtime and risk government shutdowns. But they say current circumstances are unlike any other previously and threats to their livelihoods and patient care are more serious than ever before.
Congress has until midnight Tuesday to agree on how to proceed to stave off a shutdown. Republicans, prodded by the White House, are angling for a “clean” continuing resolution that will continue existing funding conditions are until late November.
Democratic congressional leaders were holding out for concessions from recent executive and legislative actions pertaining to Medicaid cuts and other aspects of healthcare.
President Trump has threatened layoffs and permanent federal workforce reductions, holding firm on demands after he and congressional leaders from both parties and both chambers of Congress failed to bridge their differences Monday afternoon.
The ongoing turmoil and uncertainty has long-term care providers most on edge. Medicare and Medicaid will continue to be funded during a shutdown, stakeholders readily agree, and a shutdown that is not drawn out may not be too harmful. But many essential support services, survey activities and other important functions will not be spared from the outset and a drawn out shutdown will be hurtful.
“Under a lapse, the Centers for Medicare & Medicaid Services would be largely unable to provide oversight to many of its major contractors, including the Medicare Administrative Contractors, the Medicare Call Center, and other IT contractors,” noted Linda Couch, senior vice president for policy at LeadingAge. She added that while Medicare funding should not be impacted, the processing and payment of Medicare claims could be delayed, since that is carried out by Medicare Administrative Contractors.
She also expressed dismay at the Office of Management and Budget’s “eagerness to hollow out some federal programs” by permanently eliminating some positions.
“The agencies have lost significant capacity already this year, and it will likely make the shutdown-related contingency operations even harder,” she added in a statement to McKnight’s Long-Term Care News. “This is a moment to defend and protect programs.”
Jobs and telehealth fears
Enrolling new beneficiaries, appeals, surveys, dispute resolutions, audits and reimbursements may all be affected, warned Rajeev Kumar, the immediate past president of the Post-Acute and Long-Term Care Medical Association.
“This shutdown threatens to lay off many workers permanently and we still don’t know who will be affected and how severe the ramifications will be,” he added.
Kumar, like many others, said he is worried about the possible loss of telehealth flexibilities that were first granted under pandemic waivers and were extended under a March 2024 continuing resolution. They are in danger of expiring Wednesday without lawmaker intervention.
“Operators, patients and clinicians alike will be adversely affected on Day 1 of the shutdown because of that,” Kumar said. “Telehealth flexibility is crucial.”
Physician pay for long-term care services also is set to be cut, which would be “devastating” for the sector, he said.
“This administration and their policies and priorities are unlike any others preceding them, and there’s an element of unpredictability and uncertainty about the shutdown process and potential solutions that make it distinctly unique,” Kumar said.
Protecting telehealth provisions and the Medicare Part B physician fee schedule are the top extension priorities for ADVION CEO Cynthia Morton. There seems to be bipartisan agreement in these areas, but she said nothing can be taken for granted.
Nurses speak out
Nurse leaders also dread what could be coming.
“Our biggest concern is the operational instability caused by funding uncertainty,” said Janine Finck-Boyle, senior vice president of engagement for the American Association of Post-Acute Care Nursing. “Disruptions to the administrative, regulatory or payment infrastructure — such as delayed reimbursements, paused oversight activities, or limited guidance from CMS — can still have significant ripple effects on day-to-day facility operations.”
The first signs of strain will appear in cash flow, Finck-Boyle noted.
“Slower claims processing and delayed reimbursements will quickly put pressure on payroll, vendor obligations and essential services. … A prolonged disruption could force providers to make difficult financial decisions,” she added.
A reduction in oversight means routine inspections, recertifications and follow-up surveys are suspended, potentially delaying quality improvement efforts. Any stop-gap bill or temporary solution should ensure uninterrupted Medicaid and Medicare payment processing so clinical staff – as well as important CMS survey and regulatory staff – can continue their tasks.
The administration’s call for federal agencies to prepare reduction-in-force (RIF) plans instead of for customary temporary furloughs – is one of the most concerning aspects of this political showdown, FInck-Boyle believes.
Leaders at the American Health Care Association said Monday they are hopeful telehealth provisions will be made permanent in any package. Otherwise, they were withholding deeper comments until a shutdown actually arrives.
Unwelcome mysteries
The mere fact that a lot is still unknown is “troubling,” said Chad Worz, Pharm.D., CEO of The American Society of Consultant Pharmacists.
“This shutdown possibility seems to have a spin where the president may use the shutdown to RIF additional government employees and programs that he feels are costly and not aligned with his priorities. Typically, HHS is considered ‘essential’ but it’s unknown with the above potential what services or programs might be eliminated, held or continued,” Worz told McKnight’s.
He said the inability to seal a legislative deal also is creating anxiety over whether work needed to implement the Inflation Reduction Act drug pricing initiatives will go forward or be put on hold.
“We are inside 65 business days from the implementation of those provisions and much of the technology modules to capture and ensure proper pricing and payment are being built by CMS and CMS contractors,” Worz noted. “In an already daunting implementation and very short timeframe, disruption at this point could be extremely disruptive, further threatening patient access to necessary pharmacy services.”