On Wednesday, October 1st, the U.S. government officially shut down, as Congress failed to reach an agreement to extend federal funding. This is the first government shutdown since 2019.
Although the House narrowly approved a short-term extension on September 19th, the Senate rejected both Republican- and Democrat-backed efforts multiple times since. As a reminder, 60 votes are needed in the Senate for any government funding bill, meaning 7 Democrats will need join all 53 Republicans to approve the package.
ACG will continue to keep members updated about the progress of negotiations to restore funding. For now, here is what you should know, issue by issue:
Medicare and Medicaid claims processing
Medicare is considered a mandatory program and claims will continue to be processed, although payment may be slowed. CMS says it also has sufficient funds to operate the Medicaid program through the end of 2025.
CMS is also instructing Medicare Administrative Contractors to temporarily hold claims for 10 business days. ACG members may continue to submit claims during this period, but payment will not be released until the hold is lifted.
Telehealth flexibilities
The COVID-era Medicare telehealth flexibilities expired on September 30th, meaning pre-pandemic restrictions are again in place. This means Medicare beneficiaries cannot receive telehealth in their home for non-behavioral healthcare, and site-of-service requirements are reinstated for rural patients. Hospitals must also end their ‘hospital-at-home’ programs by either admitting patients to an inpatient setting or discharging care entirely.
For Medicare Advantage plans, telehealth coverage may differ on a payor-to-payor basis. And while providers are still technically permitted to offer telehealth services under traditional Medicare, the claims will not be reimbursed unless Congress authorizes back pay.
ACG is dismayed that Congress did not act to avoid this scenario, where our patients may struggle to access critical GI services. In the coming months, we will continue to urge Congress to adopt an extension of telehealth coverage – either as part of a government funding package or the normal appropriations process.
Affordable Care Act enhanced tax credits
The enhanced tax credits for ACA marketplace premiums that passed in the 2021 COVID-19 relief package are set to expire on Dec. 31st, unless Congress acts.
Although the tax credits are not directly impacted by the government shutdown, Senate Democrats have demanded their extension as part of any government funding package. Some Senate and House Republicans appear open to a temporary extension, but to date, they have been unwilling to include them in negotiations to end the shutdown.
ACG expects payors to publish their ACA marketplace insurance 2026 rates any day now. If the enhanced credits expire, the Congressional Budget Office expects 4 million Americans will drop their ACA insurance plans. According to a KFF analysis, insurance premiums are expected to rise by more than 75%. KFF also estimates that roughly 90% of the total growth in the ACA marketplaces since 2020 have come from states that voted for President Trump in the 2024 election.
NIH funding
Only a few NIH functions are considered essential, including the safety and continued care of patients its biomedical research hospital and the necessary maintenance for ongoing experiments and facilities.
Relevant to ACG members, NIH grants are somewhat affected. Existing grants will continue to be funded and research can therefore continue. For new grants, while applications may still be submitted, no peer review meetings or approvals will occur. In addition, grant administrators may be furloughed and thus unavailable to NIH-funded researchers.
Throughout 2025, ACG has heard member concerns over proposed NIH funding cuts and delays, and we recognize the additional, unfortunate impact the government shutdown may have on important research.
In August, in more than 20 letters to key Senators and House Representatives, the ACG Governors emphasized the importance of biomedical research, both for our patients and on the economies of states and local communities. ACG will continue to push Congress to adopt the Senate’s FY2026 funding plans, which call for a $400 million increase to the NIH’s budget and rejects the Trump Administration’s proposed 15% cap on indirect costs.