Government Shutdown Disrupts 92% of Hospital-at-Home Programs, Survey Finds
A large majority of hospital-at-home programs have been disrupted by the ongoing federal government shutdown, which has entered its fourth week. According to a new survey by the Hospital at Home Users Group, 92% of programs have been affected, with more than half of healthcare organizations either permanently or temporarily halting services.
Shutdown Ends Key Medicare Waiver
The disruption stems from the expiration of a Centers for Medicare & Medicaid Services (CMS) waiver on September 30, which coincided with the start of the government shutdown. The waiver had allowed hospitals to bill Medicare for care provided under the hospital-at-home model.
The waiver, first introduced during the COVID-19 pandemic in 2020, enabled hospitals to deliver acute-level care in patients’ homes. Since its launch, more than 400 hospitals across 39 states had received approval to operate under the program.
Without the waiver, many health systems have lost the ability to bill Medicare for hospital-at-home services, forcing widespread program suspensions.
Programs Halt or Scale Back Care
The survey, which included 140 hospital-at-home programs, found that:
- 35% have stopped providing care to traditional Medicare patients under the now-expired CMS waiver.
- 20% ended treatment for patients not covered by the waiver.
- 23% transitioned all or part of their services to outpatient home care models.
Before the shutdown, hospital-at-home programs reported an average of 5.58 daily admissions. Following the loss of the waiver, that figure dropped to 1.84, representing a 67% decline in daily patient volume.
Uncertain Future for Home-Based Acute Care
Industry observers have expressed concern that the prolonged lapse of federal authorization could erode momentum for hospital-at-home care, a model many health systems have credited with expanding access, reducing costs, and improving patient satisfaction.
The survey data, shared with Becker’s on October 28, underscores how dependent the model has become on federal reimbursement mechanisms. Until the CMS waiver or an equivalent program is reinstated, many hospital-at-home providers are expected to continue scaling back or pausing services.
