Short-term extension of key Medicare policies

Congress ends longest congressional shutdown and includes short-term extension of key Medicare policies  (Source: AMA)

After more than 40 days, the longest shutdown of the federal government caused by a lapse in appropriations funding ended on Nov. 12 following congressional passage of H.R. 5371, the Continuing Appropriations and Extensions Act, 2026. Despite the prolonged federal shutdown, H.R. 5371 only fully funds the Department of Agriculture, Department of Veterans Affairs, Department of Defense’s Military Construction activities, and legislative branch for the entirety of the 2026 fiscal year, which ends on Oct. 1, 2026. The Food and Drug Administration (FDA) received full funding due to its inclusion in the Department of Agriculture appropriations bill. Congress, however, only allocated funding for the remainder of the federal government, including the Department of Health and Human Services, through Jan. 30, 2026.

H.R. 5371 does include temporary extensions of numerous AMA-supported provisions that expired on Oct. 1 due to the inability of Congress to pass compromise legislation. More specifically, all existing telehealth flexibilities (i.e., suspension of the statutory geographic and originating site restrictions originally enacted during the COVID-19 public health emergency), the hospital-at-home waiver, and 1.0 work geographic practice cost index (GPCI) floor were extended through Jan. 30. In addition, the Community Health Center Fund, National Health Service Corps (NHSC), Teaching Health Center Graduate Medical Education Program (THCGME), as well as the Special Diabetes Program for Type I Diabetes and Native Americans, was also extended until the end of January 2026. The new Jan. 30 deadline also extends the moratorium on data reporting requirements and associated payment cuts to the Clinical Laboratory Fee Schedule that were initially implemented following passage of the Protecting Access to Medicare Act (PAMA) of 2014.

Finally, Congress included provisions to waive “Statutory Pay-As-You-Go (PAYGO)” requirements that were triggered following passage of H.R. 1, the One Big Beautiful Bill Act, in July 2025. Under the Statutory PAYGO Act of 2010, if a law increases the deficit over a five or ten-year period, a mandatory sequester, or an across-the-board-cut, is triggered. The Office of Management and Budget (OMB) tracks the budgetary effects of all laws passed by Congress during a specific legislative session on two scorecards. While Congress has never permitted these cuts going into effect, Medicare, as well as numerous other federal programs, are affected by Statutory PAYGO cuts. Absent congressional intervention, Medicare was slated for an approximately $530 billion cut associated with the long-term fiscal impact of previously passed bills, including the One Big Beautiful Bill Act. Section 8001 of H.R. 5371 directs OMB to clear the scorecards and eliminates any potential associated sequester cuts, including in Medicare.

The compromise legislation did not include any extension of the Affordable Care Act (ACA) Enhanced Premium Tax Credits (EPTCs) that are still slated to expire at the end of 2025. In September, the AMA and many other state and national medical specialty societies sent a bipartisan, bicameral letter (PDF) pressuring congressional leadership to extend the tax credits before the end of 2025. While bipartisan members of the Senate pledge to hold a vote on a potential extension of the ACA EPTCs in December in exchange for passage of H.R. 5371, the House of Representatives has not offered a similar commitment, to date. AMA will continue to closely monitor the ongoing congressional debate surrounding the ACA EPTCs and federal funding.