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The ongoing government shutdown, sparked by stalled negotiations between Republicans and Democrats over federal funding, is shaking up several sectors, including healthcare. Despite the disruption, the Centers for Medicare & Medicaid Services (CMS) confirmed that the Independent Dispute Resolution (IDR) process for out-of-network billing disputes remains active, at least for now.

According to a recent CMS notice, healthcare providers and insurers can still file disputes through the online IDR portal, and certified mediators will continue processing them. However, CMS cautioned that if the shutdown continues for an extended period, response times and reviews may face significant delays.

The IDR system, launched in 2022 under the No Surprises Act, has long been criticized for its large backlog. CMS recently reported progress, stating that dispute resolutions are now being completed faster than new ones are submitted. The agency attributed this improvement to automation upgrades, new guidance materials, and enhanced collaboration with mediators.

Meanwhile, political discussions around the shutdown remain stalled. As of October 7, neither party has made progress toward reopening the government or extending Affordable Care Act (ACA) premium tax credits, one of the key issues in the funding standoff.

ACA Tax Credit Extension Gains Bipartisan Support

A new KFF Health Tracking Poll revealed that most Americans favor extending the enhanced ACA premium tax credits. Among 1,334 adults surveyed, 78% supported continuing the subsidies, including 59% of Republicans, 82% of independents, and 92% of Democrats. However, nearly 60% of marketplace enrollees said they were unaware of the upcoming expiration.

KFF CEO Drew Altman warned that many consumers could face sticker shock when premiums rise in November, adding that 42% of respondents would consider dropping coverage if rates double.

CMS Ends Expanded Telehealth Flexibilities

On the first day of the shutdown, CMS released updated guidance confirming the expiration of pandemic-era telehealth waivers for Medicare beneficiaries. While providers can continue submitting claims, CMS has instructed contractors to hold telehealth payments for 10 business days.

Under pre-pandemic rules, telehealth visits must occur at rural facilities, excluding most urban patients. Audio-only visits are also no longer covered. Some telehealth options remain, such as those for dialysis and certain Accountable Care Organization (ACO) participants.

Industry groups including the Alliance for Connected Care and the American Telemedicine Association praised CMS for temporarily holding claims, saying it may help reduce administrative chaos during the funding lapse.

What’s Still Operating at HHS

According to the Department of Health and Human Services (HHS) contingency plan, 41% of staff, over 32,000 employees, will be furloughed during the shutdown. Critical services such as Medicare, Medicaid, and fraud prevention programs will continue. The National Institutes of Health (NIH) will maintain direct medical care for patients but suspend most research activities. The Centers for Disease Control and Prevention (CDC) will limit public communications.

The Food and Drug Administration (FDA) will retain roughly 86% of staff but won’t process new drug, biologic, or device applications requiring user fees until the shutdown ends.

Reactions from the Healthcare Community

Several organizations voiced frustration over the shutdown’s effects:

• National Nurses United blamed Republican lawmakers for creating unnecessary instability in public health services.
• The Catholic Health Association urged Congress to reach a swift resolution, warning that millions could lose access to care.
• The American Academy of Family Physicians called on leaders to remember the real-world impact of delayed healthcare funding.