The ongoing federal government shutdown has halted one of Medicare’s most innovative and patient-centered programs ,the Acute Hospital Care at Home initiative, forcing hospitals to bring patients back into already strained facilities ahead of flu season.
The program, first launched in 2020 under a pandemic-era waiver, has allowed more than 330 hospitals to provide acute-level care for stable patients in their own homes while still receiving Medicare reimbursement. The approach has proven successful: lower mortality rates, fewer readmissions, and better patient satisfaction compared with traditional inpatient care. But because Congress failed to pass a continuing resolution, the waiver that authorizes Medicare payments for hospital-at-home programs has lapsed, leaving hospitals without a funding mechanism.
Hospitals like UMass Memorial Health and ChristianaCare have already paused or drastically scaled back participation. “Patients who have chosen to be treated at home are facing limited space at hospitals and increased risk of falls and other negative events when they are moved to an unfamiliar environment,” said Beth Feldpush, senior vice president at America’s Essential Hospitals.
Before the shutdown, UMass Memorial treated nearly 4,000 patients through its home program, cutting ER boarding in half and reducing post-acute care costs. Now, capacity pressures are again mounting. Memorial Health’s Dr. Constantinos Michaelidis said the number of patients waiting for a bed has already risen from 50 to nearly 70 — a troubling sign ahead of the winter surge in flu, RSV, and COVID-19 cases.
The program’s future hinges on Congress. Rep. Vern Buchanan (R-Fla.) introduced bipartisan legislation to extend the waiver for five years, which passed the House Ways and Means Committee but remains stalled in the Senate. Advocacy groups — including Moving Health Home, the American Telemedicine Association, and the Alliance for Connected Care — are calling for immediate action.
Without a fix, experts warn, the shutdown will erode trust in government-backed care innovation and discourage hospitals from investing in remote care infrastructure. “People are really in a wait-and-see mode,” said Jiang Li, CEO of Vivalink, noting that countries like Canada have outpaced the U.S. due to more consistent policy support.
Key Takeaways for Hospital Leaders
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Prepare for inpatient surges: Reassess bed capacity and staffing ahead of respiratory virus season as hospital-at-home patients return.
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Engage lawmakers: Urge Congress to permanently authorize or at least extend the Acute Hospital Care at Home waiver to provide stability and innovation continuity.
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Document outcomes: Continue gathering data on safety, cost savings, and patient outcomes to strengthen the policy case for long-term coverage.
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Diversify payer sources: Explore commercial or state Medicaid reimbursement for hospital-at-home care to reduce reliance on federal waivers.