Government shutdown watch: Various hospital funding sources to be curtailed (updated 11/07/25)

Nov. 13 update: The shutdown ends

The longest federal government shutdown on record ended on its 43rd day, Nov. 12, when the House narrowly passed a short-term continuing resolution (CR) and President Donald Trump signed it into law. The bill funds government operations through Jan. 30.

With Medicare telehealth waivers restored in the CR, healthcare providers await word from CMS on the status of claims for telehealth services furnished since the shutdown began Oct. 1.

One of the biggest unresolved issues is the status of the Affordable Care Act enhanced subsidies for 2026. Senate Democrats secured a pledge that a vote on an extension would be held by mid-December, but that may leave little time to put anything in place amid the ongoing open enrollment period.

We covered the subsidy issue as part of a recent update.

Nov. 11: A resolution to the shutdown appears close

As the shutdown reached the seven-week mark, the end appeared near, with eight Senate Democrats joining Republicans to pass a spending bill that would fund federal operations through Jan. 30.

The eight Democrats first provided the support needed to advance the bill on Nov. 9 for a formal vote, then helped pass the bill on the evening of Nov. 10. The bill now heads to the House, where Republicans will need virtual unanimity to ensure passage. They can lose only two votes if all Democratic representatives oppose the measure.

Check out our coverage of the key healthcare provisions that are — and are not — in the bill.

Nov. 7: CMS issues a further update on telehealth claims

A subset of telehealth claims is being sent back to providers because of confusion as to whether Medicare coverage waivers still apply to those claims during the government shutdown, CMS announced.

Since its most recent announcement, CMS was instructing Medicare administrative contractors (MACs) to approve telehealth claims only if they are confirmed to be for behavioral health services or for home-based treatment of patients who have mental, behavioral or neurodevelopmental disorders (physical therapists, occupational therapists, speech language pathologists and audiologists are not eligible for payment, however).

But in its new announcement, CMS said MACs have struggled to identify all the claims that are currently payable, in part due to information that may be left off behavioral health claims to protect patient privacy. MACs have been holding telehealth claims that are not identifiable, as well as those filed by clinicians in Medicare Shared Savings Program (MSSP) accountable care organizations, which are supposed to still be eligible for payment.

CMS now plans to return those claims to providers if submitted between Oct. 1 and Nov. 10 (for services that have taken place since Oct. 1). Providers can seek to resubmit the claims.

Guidance for future claims submission

Until the waivers are restored, claims still can be submitted as usual by MSSP participants, along with clinicians providing behavioral and mental health services (except for PTs, OTs, SLPs or audiologists) and monthly clinical assessments related to end-stage renal disease. MACs will strive to confirm whether those claims are eligible for payment.

For all other telehealth services, providers can choose to submit claims but now should include the GY modifier, signifying that the service currently is not eligible for payment.

Per the announcement, “Should Congress act in the future and restore a broader range of telehealth services payable by Medicare, CMS will provide future guidance on whether practitioners will need to resubmit telehealth claims that included the GY modifier.”

Guidance on hospital-at-home

The issue is a little clearer with respect to the Acute Care Hospital at Home program, for which payment waivers also expired Oct. 1. CMS had instructed hospitals to discharge all hospital-at-home patients or transfer them to the hospital. For such services provided Oct. 1 or later, MACs have been returning claims to providers.

New guidance advises that hospitals can submit (or resubmit) the claims for denial, thus giving the beneficiary and hospital the rights they are due when a service is denied.

“Should Congress act in the future and retroactively extend the waivers, CMS will provide future guidance on whether hospitals will need to resubmit AHCAH claims previously submitted for non-covered days or denial,” according to the new announcement.

Nov. 3: Efforts gain steam to find a bipartisan solution to the Affordable Care Act subsidy question

A bipartisan quartet in the House has developed the outline of a plan that would extend the enhanced subsidies for Affordable Care Act (ACA) marketplace premiums. If the proposal gains traction, it could sway enough Democrats in the Senate to vote to end the government shutdown, which on Wednesday will become the longest on record at 36 days.

The subsidies would be extended for two years, through 2027. Subsidy amounts would decrease for households starting at an annual income of $200,000, phasing out completely at $400,000.

Since the enhanced subsidies were implemented in 2021, there has been no income cap, with any household eligible for a partial subsidy if its premium amounts to more than 8.5% of income. The permanent subsidies that were passed as part of the ACA in 2010 limit eligibility to households between 100% and 400% of the federal poverty level.

The new proposal also would incorporate additional guardrails to support program integrity. ACA marketplaces would need to cross-check recipients with the Death Master File maintained by the Social Security Administration and would need to enhance their communications to recipients about subsidy amounts. There also would be more scrutiny on agents and brokers trying to enroll people in marketplace plans.

Oct. 29: Oz says expiration of Affordable Care Act subsidies would be OK

Speaking to reporters in Washington, D.C., Mehmet Oz, MD, administrator of CMS, indicated that he supports the expiration of enhanced subsidies for buying Affordable Care Act (ACA) marketplace insurance.

Republicans in Congress have said they are open to discussing a potential extension of the subsidies if Democrats first supply the Senate votes needed to pass a short-term government funding bill. But Oz, who oversees the agency that coordinates the marketplaces, suggested a subsidy continuation is unnecessary.

Oz said there is not a pressing need to retain the enhanced subsidies despite the prospect that ACA marketplace premiums will rise significantly for many enrollees who previously were subsidized.

“I think we all agree that COVID has passed, so therefore COVID-era subsidies should pass,” Oz said, referring to the higher subsidies that Congress approved in 2021.

He said roughly half of the 24.3 million ACA marketplace enrollees in 2025 never used their insurance, potentially indicating they were enrolled without their knowledge.

He noted that, as seen in figures released the prior day by CMS, the average marketplace plan will carry a $50 monthly premium when applying the permanent ACA subsidies. That would be only $13 higher than in 2025.

In insights posted after CMS released the 2026 premiums, KFF noted that maintaining coverage with roughly the same premiums as in 2025 would require many people to shift to an ACA Bronze plan with a deductible of more than $7,000. With the enhanced subsidies, they could retain a Silver plan where the deductible would be as low as $100.

Oz spoke during a Trump administration news conference to announce a new initiative to speed the development of biosimilar drugs as a mechanism for reducing costs. Watch his comments courtesy of PBS.

Oct. 28: CMS releases information on 2026 Affordable Care Act marketplace premiums

In a fact sheet released late Tuesday, CMS promoted the Nov. 1 start of open enrollment for 2026 health plans available through the Affordable Care Act marketplaces. The fact sheet pertains to the 30 states in which residents sign up for ACA plans using Healthcare.gov (as opposed to through state-run marketplaces).

CMS sought to play up the continued affordability of ACA plans amid questions about the status of enhanced subsidies for purchasing a plan. The agency said enrollees will “continue to have robust access to low premium plans after applying advance payments of the premium tax credit.”

For low-premium, high-deductible plans (e.g., Bronze plans), the non-enhanced subsidies are projected to cover 91% of premiums and result in an average premium of $50 per month. CMS says that would be $13 higher than in 2025 but less expensive than in 2020, the most recent year before the enhanced subsidies were implemented by Congress.

Nearly 60% of people seeking to reenroll are expected to have access to a plan for which the premium is no more than $50 per month after applying the continued subsidy, down from 83% in 2025.

Of the 30 Healthcare.gov states, 19 have at least as many participating health plans as they did in 2025. And 95% of enrollees can choose from among three or more health plans, roughly the same percentage as in 2025, the fact sheet states.

New features in the marketplaces for 2026 include expanded eligibility to enroll in catastrophic plans for people who no longer qualify for subsidized coverage due to the expiration of the enhanced subsidies. In addition, a provision in the One Big Beautiful Bill Act will make all Bronze and catastrophic ACA plans linkable to health savings accounts.

Health system CEO thinks Affordable Care Act subsidies will be renewed

In an investor call Tuesday to report Q3 financials, Saum Sutaria, MD, the CEO of Tenet Healthcare, said his organization remains confident that Congress will renew the enhanced subsidies going into 2026.

“We’re not planning, nor are we saying that we expect them to expire at this stage,” Sutaria said. “I think much of what we’re hearing is that it may take time, but a compromise will be achieved [according to] our intelligence coming from Washington. We’re just sort of patiently waiting to see what happens there.”

Republicans in Congress have said they will agree to discuss an extension of the subsidies if Democrats first sign off on a short-term bill to reopen the federal government at 2025 funding levels. Democrats insist that a plan to renew the subsidies must be in place first.

A loss of subsidies would affect premiums for most of the 24.3 million people who were enrolled in an ACA health plan in 2025, with forecasts placing the resulting 2026 increase in uninsurance at anywhere between 2.2 million and 4.8 million.

Open enrollment is scheduled to start Nov. 1 and run through Jan. 15. One estimate has projected a 114% average increase in out-of-pocket premiums if the subsidies expire, equating to several hundred dollars more per month for some enrollees.

CMS has indicated it could set up a special enrollment period if the subsidies are renewed late in the open enrollment period.

Oct. 27: Most CMS survey and certification activities are on hiatus

An updated memo describes the ongoing pause in Medicare-related survey and certification of providers as conducted by states.

Processes that have been halted until the government shutdown is resolved affect initial certification and change-of-ownership applications, most surveys (initial, standard and revisit), and complaints, according to the memo issued by CMS’s Center for Clinical Standards and Quality (CCSQ).

Among exceptions to the pause, a complaint will be processed if it entails alleged immediate jeopardy or patient harm.

Revisit surveys can still be conducted at the request of a state agency if failure to conduct the survey would cause a three-month denial of payment for new admissions at the provider, or if termination of the provider’s Medicare participation within 45 days would result. Otherwise, providers that were in the survey cycle when the shutdown began should not expect a revisit survey until full government operations restart.

Initial surveys of Medicaid-only facilities can continue after a consultation between CCSQ and the state Medicaid agency. State licensure functions and enforcement activities also are unaffected.

In past instances when CCSQ has frozen many functions, such as during the five-week government shutdown in 2018, providers have reported facing long delays as surveyors and accreditors work their way through the backlog after regular activity resumes. Delays can temporarily affect a provider’s ability to bill Medicare after opening or acquiring a new facility.

Oct. 24: CMS brings back furloughed personnel

CMS is recalling all staff who have been furloughed since the government shutdown began Oct. 1, saying the action is necessary to ensure 2026 open enrollment proceeds smoothly for Medicare and the Affordable Care Act marketplaces.

Roughly 3,000 CMS employees are estimated to have been on furlough, representing 47% of the agency’s staff. It is unclear whether the returning employees will be paid, but CMS said operations can be funded from fees charged to researchers seeking to access federal health data.

Medicare open enrollment has been underway since Oct. 15, while ACA marketplace enrollment is scheduled to begin Nov. 1. Much uncertainty surrounds the marketplaces amid the tenuous status of the enhanced subsidies for buying ACA health plans.

One administrative issue to watch for at CMS is whether annual regulations are published in early November as originally scheduled. The 2026 Medicare payment rules for hospital outpatient departments and ambulatory surgical centers, the physician fee schedule, end-stage renal disease care providers, and home health agencies are due out in a little more than a week, with an effective date of Jan. 1.

CMS is not the only agency where staffing could affect publication of the final rules, however. The Office of Management and Budget (OMB) must clear all federal rulemaking for publication.

Oct. 21: Most held-up Medicare claims can be processed

CMS says Medicare administrative contractors (MACs) have been instructed to lift the hold on all claims that are eligible for payment during the ongoing government shutdown.

In a new notice, the agency says all claims for in-person services can start to be processed immediately. Telehealth claims for behavioral health services also can be processed, as Medicare fee-for-service payment for those services is not contingent on the waiver that has been in place since 2020.

Other telehealth claims will continue to be held rather than processed, with the hope being that the claims will be retroactively eligible for payment whenever Congress agrees to a new funding deal.

All claims remain subject to a 14-day hold, as is customary.

Clarifications on HHS cuts

In an Oct. 20 court filing, HHS said 954 staffing positions have been terminated as part of the Trump administration’s decision to pare the federal workforce amid the shutdown. The filing acknowledges that 362 of those positions are covered by a recent court order halting the terminations for members of two unions that filed lawsuits to block the workforce reductions. Most of the covered positions are part of CDC.

Oct. 16: Further clarifying the telehealth claim policy

In response to potential confusion about its Oct. 15 bulletin on telehealth claims (see below), CMS posted a notice that removes any mention of Medicare physician payments and federally qualified health centers in the context of Medicare fee-for-service claims to be held for the duration of the partial government shutdown.

The delay in claims processing thus applies only to telehealth and hospital-at-home, the two service lines facing coverage and payment constraints with Medicare waivers having expired in the absence of a government funding agreement.

“CMS will continue to process and pay held claims in a timely manner with the exception of select claims for services impacted by the expired provisions,” according to the new notice. “To date, no payments have been delayed as statute already requires all claims to be held for a minimum of 14 days, and this recent hold is consistent with that statutory requirement. Providers may continue to submit claims accordingly.”

Oct. 15: Updating the pause on telehealth claims

CMS announced it would seek to mitigate the potential for mass denials of fee-for-service Medicare telehealth claims by holding submitted claims while the partial government shutdown continues.

“Providers may continue to submit these claims, but payment will not be released until the hold is lifted,” CMS wrote in a bulletin.

Medicare administrative contractors previously were instructed to hold claims for 10 business days. Most telehealth claims filed for services provided since Oct. 1 would have been subject to denials starting Oct. 15 under restrictions that are in place until expanded coverage gets reauthorized.

Even with the new guidance, CMS wrote that providers “may choose to hold claims associated with telehealth services that are not payable by Medicare in the absence of congressional action.”

The agency also reiterated that it may be worth giving beneficiaries an advance notice of noncoverage for telehealth services that won’t be covered during the shutdown.

HHS layoffs stymied

A federal judge blocked the Trump administration’s plans to fire government workers during the shutdown. Roughly 4,000 federal employees were dismissed Oct. 10, including at least 1,100 at HHS, according to a court filing. President Donald Trump had said more employment terminations could be in the offing.

The initial HHS number was reduced when the department reversed course and rehired about half the CDC employees who had been terminated, according to reports.

Wednesday’s restraining order by Judge Susan Illston, a Clinton nominee at the Northern District of California federal court, came in response to a lawsuit filed by unions that argued a shutdown does not permit workforce reductions.

Oct. 10: HHS layoffs announced

HHS staff are among those affected by employment terminations that the Trump administration initiated across the federal government Friday.

The number of affected staff within the department was not announced, but a court filing put Friday’s total at between 1,100 and 1,200. It’s likely that those losing their jobs are from the pool of more than 32,000 employees who were furloughed for the duration of the ongoing government shutdown.

“All HHS employees receiving reduction-in-force notices were designated non-essential by their respective divisions,” according to a statement. “HHS continues to close wasteful and duplicative entities, including those that are at odds with the Trump administration’s Make America Healthy Again agenda.”

CDC, the Agency for Healthcare Research and Quality, and the Health Resources and Services Administration (HRSA) may bear the brunt of the job cuts, according to a CNN report. HRSA administers the 340B Drug Pricing Program and by Oct. 15 was scheduled to finish evaluating the proposals of drug manufacturers to participate in a rebate model scheduled to begin Jan. 1.

President Donald Trump had said mass firings were possible depending on the length of the partial shutdown, which began Oct. 1. According to reports, employees must be given at least 30 days’ notice before their job termination takes effect.

An estimated 20,000 HHS staff members already have left the department this year through either job terminations or voluntary departures. Those firings have been contested in federal court, and the administration’s latest moves also are the subject of legal challenges.

Oct. 9: Democrats criticize interim policy on telehealth claims

A pair of Democratic congressional leaders wrote to HHS and CMS, urging the Trump administration to better support patients and providers amid potential confusion about the status of telehealth claims.

Medicare coverage of telehealth services was significantly restricted starting Oct. 1, when Congress failed to pass a federal funding bill that would have included an extension of the waivers that have been in place since the COVID-19 pandemic.

“Seniors across the country have reported widespread disruptions and inability to schedule routine telehealth appointments since the beginning of the month,” according to a news release from Rep. Richard Neal (D-Mass.), ranking member on the House Ways and Means Committee.

Neal and Rep. Frank Pallone (D-N.J.), ranking member on the Energy and Commerce Committee, signed the Oct. 9 letter to HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet Oz, MD.

Requests for CMS

Neal and Pallone wrote that the 10-day hold on telehealth claims is inadequate and, as things stand, will lead to denials of Medicare telehealth claims starting Oct. 15.

CMS should use its authority to indefinitely hold payments for the duration of the shutdown, allowing providers to continue furnishing telehealth services and ultimately be reimbursed, according to the letter.

“On numerous occasions in the past, the agency has directed providers to hold claims for longer than 10 business days,” the Democratic leaders wrote.

Also, providers should be reminded that they can submit a Medicare claim for up to a year after the date of service, Neal and Pallone stated.

“This clarity will ensure that Medicare providers know they can hold their claims until an extension is resolved,” they wrote.

They also noted that Medicare payment has ceased for acute-care hospital-at-home (AHCaH) services at least while the shutdown is ongoing.

“To help alleviate confusion and care disruption, CMS should provide such guidance and lengthen the time it holds AHCaH claims,” the Democratic congressional leaders wrote. “This would ensure that hospitals participating in AHCaH know that claims can be held up to a year before submitting to CMS for payment.”

Note regarding MA

While the telehealth restrictions apply to fee-for-service Medicare for at least as long as the shutdown lasts, Medicare Advantage (MA) plans appear to be maintaining expanded coverage.

Oct. 3: No Surprises Act IDR portal is operational

Regarding the No Surprises Act independent dispute resolution (IDR) portal for resolving out-of-network payment disputes between providers and health plans, CMS sent notice that the IDR process would remain in operation, with standard timelines applying.

“However, please note that a prolonged lapse in appropriation may cause delays in the review and processing of IDR complaints and response times to inquiries,” CMS wrote.

Oct. 1: Some Medicare claims processing is frozen

CMS has instructed Medicare administrative contractors to put a temporary hold on Medicare claims, given the uncertainty brought on by the shutdown. The concern primarily pertains to telehealth claims (see details below).

“This standard [claims holding] practice is typically up to 10 business days and ensures that Medicare payments are accurate and consistent with statutory requirements,” CMS wrote in guidance. “The hold prevents the need for reprocessing large volumes of claims should Congress act after the statutory expiration date and should have a minimal impact on providers due to the 14-day payment floor. Providers may continue to submit claims during this period, but payment will not be released until the hold is lifted.”

Until the shutdown is resolved, providers may want to consider their options for scenarios involving impacted telehealth services.

“In the absence of congressional action, practitioners who choose to perform telehealth services that are not payable by Medicare on or after Oct. 1, 2025, may want to evaluate providing beneficiaries with an Advance Beneficiary Notice of Noncoverage,” CMS wrote. “Practitioners should monitor congressional action and may choose to hold claims associated with telehealth services that are not payable by Medicare in the absence of congressional action. Additionally, Medicare would not be able to pay some kinds of practitioners [e.g., physical therapists, occupational therapists] for telehealth services.”

The telehealth restrictions in place during the shutdown do not apply to clinicians participating in the Medicare Shared Savings Program, CMS noted.

Original story (Sept. 30)

With Congress unlikely to immediately agree on a bill to fund the government beyond Sept. 30, consequences include a reduction in Medicaid disproportionate share hospital (DSH) payments and the expiration of Medicare waivers that authorize expanded coverage of telehealth and in-home acute care services.

Those cutbacks would be temporary, in all likelihood, lasting for however long it takes the parties to agree to a funding measure.

House Republicans narrowly passed a seven-week continuing resolution (CR) that would prevent the start of the DSH cut and the other healthcare reductions for the duration of the CR. But in the Senate, the votes of at least seven Democrats are needed to reach the 60-vote threshold that ensures the bill can get through the upper chamber.

Democrats have said they will not provide those votes unless Republicans negotiate an extension of the enhanced subsides for buying Affordable Care Act (ACA) marketplace insurance. Without an extension, the subsidies will expire at the end of 2025, potentially leading to significant numbers of disenrollments.

HHS cutbacks

One consequence of a shutdown would be a temporary contraction of HHS, with plans to furlough more than 32,000 of nearly 80,000 employees. President Donald Trump has said he might fire nonessential federal employees if a shutdown drags on long enough.

A published contingency plan notes that funding for 35,000 employees is drawn from mandatory spending programs — namely Medicare, Medicaid, the Children’s Health Insurance Program and the Indian Health Service — and therefore is not subject to the appropriations process. The HHS Office of Inspector General also receives mandatory funding.

Another 12,000 employees are considered integral to the discharge of constitutionally required operations. Those employees would be expected to work without pay until government funding is restored, at which time they would receive full back pay. Furloughed federal employees also are entitled to back pay.

Programs that would continue as usual include those that support preparedness for emergencies such as natural disasters and disease outbreaks.

In addition, “Operating Divisions with a substantial direct service component will have more of their staff retained,” HHS states.

Shares of employees who would stay on at HHS agencies include 86% at FDA, 53% at CMS, 36% at CDC and 24.5% at the National Institutes of Health.

“In the event of a prolonged lapse period, HHS Operating and Staff Divisions will work with the Office of the General Counsel to identify the legal rationale for any changes in activities deemed necessary to protect the health and safety of Americans and will update the lapse plan on a rolling basis to meet these operational needs as they arise,” according to the contingency plan.

Agency impact

As examples of activities that would cease amid the furloughs, HHS states that “CDC communication to the American public about health-related information will be hampered … and NIH will not have the ability to admit new patients to the Clinical Center, except for whom it is medically necessary.”

CMS will have funding to sustain full Medicaid reimbursement at for at least one fiscal quarter (i.e., through December), HHS said, while Medicare is fully funded over the long term by the program’s trust funds. But CMS does not promise that claims processing, payments and responses to provider inquiries will be administratively maintained at full capacity for the duration of a long funding lapse.

“A prolonged shutdown would deplete funding for Medicare administrative contractors [MACs], causing significant delays in payments to healthcare providers,” according to a news release from the office of Rep. Brad Sherman (D-Calif.).

With an estimated 47% of CMS staff on furlough, the agency would be unable to maintain certain healthcare facility survey and certification activities (e.g., verification, initial surveys and less-serious complaint investigations), oversight of contractors (MACs, Medicare call centers, IT contractors), and some outreach and education activities (including Medicare card-replacement mailings).

Hospital DSH funding

An $8 billion cut to Medicaid DSH payments would kick in for FY26, with the same reduction scheduled for FY27 and FY28 as well. The annual total amounts to a 48.9% decrease, relative to scheduled federal DSH funding of $16.37 million, according to projections in a 2024 report by the Medicaid and CHIP Payment and Access Commission (MACPAC).

The impact of the cut would vary significantly by state. Percentagewise, for example, Illinois and Massachusetts would lose more than 80% of their DSH funding, while Montana would lose less than 5% (see the table that starts on page 87 of the MACPAC report).

The schedule of payments ranges from monthly to semi-annually, depending on the state. Theoretically, hospitals would begin to feel the effects with the first payment they receive in October or later.

But assuming the full DSH rate is restored when Congress agrees on a government funding bill, the payment reduction would be unlikely to have a widespread material impact. The eventual bill could include retroactive payments.

Telehealth

Waivers authorizing expanded Medicare coverage of telehealth have been in place since the start of the COVID-19 pandemic but could end, at least temporarily.

Without a CR, most services provided to beneficiaries in their homes would cease to be eligible for reimbursement. Services would be payable only when a patient receives telehealth in a rural provider setting (e.g., a critical access hospital).

Behavioral healthcare would continue to be payable when furnished to patients in their homes in any geographic area, as would dialysis services. However, a requirement for an initial behavioral telehealth visit to be preceded by an in-person visit within six months would be restored, and home dialysis patients would need to make monthly in-person visits during each of the first three months of their home care.

Hospital-at-home

The acute-care hospital-at-home waiver has allowed hospitals to receive Medicare inpatient payment rates for providing hospital-level care in a patient’s home. But that waiver is set to immediately expire until a CR or other budget bill is ratified.

“This kind of care is well suited for medium-acuity patients who need hospital-level care but are considered stable enough to be safely monitored from home,” the American Hospital Association wrote in a brief, which also noted that 400 hospitals across 39 states have been approved to provide hospital-at-home care.

The current expectation among stakeholders is that Medicare will immediately stop covering hospital-at-home services until a government funding bill is passed, rather than attempting to phase in the expiration of funding.

Other funding

Two categories of hospitals that could be especially hampered by a shutdown are designated low-volume hospitals and Medicare-dependent hospitals. Vital supplemental funding, estimated to total $500 million per fiscal year, is set to expire Oct. 1 for those facilities.

Rural physician practices would face challenges stemming from the hiatus of the legislated floor for the work geographic practice cost index. The floor is intended to ensure rural practices can pay competitive wages.

Money for graduate medical education (GME), including for academic medical centers to train medical professionals in community settings, would be unavailable for the duration of a shutdown. GME for pediatric residency programs also would be terminated until a government funding bill passes.

Community health centers also would lose their funding, as would the National Health Service Corps, which bolsters the supply of primary care clinicians in designated areas with a shortage of such professionals. Additional funding that previously has been slotted for ambulance services in rural areas also would be halted.