Government Shutdown and Home Health Claims: What Happens to Medicare Payments If Funding Lapses After December 11, 2026

If federal funding lapses after December 11, 2026, Medicare keeps paying home health claims. Medicare pays out of trust funds. CMS's own lapse plan says the Medicare program continues. In the last long shutdown, CMS told providers that the Medicare Administrative Contractors (MACs) would keep processing and paying fee-for-service claims. What stops is most of the survey and certification work.

As of October 7, 2026, the government runs on the Continuing Appropriations and Extensions Act, 2027, Public Law 119-103, signed September 2, 2026. No full-year bill or new stopgap has been enacted. This page does not guess what Congress will do. It explains what a lapse does, from the law and CMS's instructions in the October 1 to November 12, 2025 shutdown.

One correction. The September stopgap carries no Medicare telehealth or hospital-at-home extension. Those were settled in February. For a home health agency, December 11 is a funding deadline, not a Medicare payment cliff.

What the December 11 Date Actually Is

Section 106 of Public Law 119-103 says its funding is "available until whichever of the following first occurs": an appropriation for the activity is enacted, the full-year fiscal year 2027 bill is enacted without it, or "(3) December 11, 2026."

Division B of the same law moves several program deadlines to December 11, 2026. The only Medicare item in it is section 2007, which changes the dollar amount in the Medicare Improvement Fund. The word "telehealth" does not appear anywhere in the law. Neither does "home health."

Why Medicare Claims Keep Paying

Medicare pays benefits from two trust funds the Social Security Act created. For the Hospital Insurance Trust Fund, section 1817(h) says the Managing Trustee "shall also pay from time to time from the Trust Fund such amounts as the Secretary of Health and Human Services certifies are necessary to make the payments provided for by this part." Section 1841(g) says nearly the same for the Supplementary Medical Insurance Trust Fund.

The current CMS contingency staffing plan opens with: "The Centers for Medicare & Medicaid Services (CMS) Medicare Program will continue during a lapse in appropriations." The department-wide plan says HHS "will also except staff as necessary to support funded activities, such as Medicare, Medicaid, and other mandatory health program payments."

Two cautions about that plan:

• It is the fiscal year 2026 plan. A lapse after December 11 falls in fiscal year 2027. As of October 7, 2026, HHS still lists the FY 2026 plan as current; the CMS page was last reviewed September 8, 2026.
• The plans change from year to year. Compare the last two.

The Medicare sentence has not moved. The staffing around it has.

Medicaid runs on a different pot. The FY 2026 Labor-HHS act already appropriated Medicaid grants to states "for the first quarter of fiscal year 2027," the quarter that ends December 31, 2026.

What Happened in the Last Long Lapse

CMS's recovery memo dates the most recent long shutdown: it "occurred from October 1, 2025, through November 12, 2025." On day one, CMS published a special edition of MLN Connects, and CGS reposted it word for word. Its last line is the one billers need: "MACs will continue to perform all functions related to Medicare Fee-for-Service claims processing and payment."

The same notice explained the claims hold that did happen: "When certain legislative payment provisions ('extenders') are scheduled to expire, CMS directs all Medicare Administrative Contractors (MACs) to implement a temporary claims hold. This standard practice is typically up to 10 business days and ensures that Medicare payments are accurate and consistent with statutory requirements."

That hold came from expiring payment provisions, not from the lapse. In 2025 both arrived together: the telehealth flexibilities then in law ended September 30, 2025, the last day funding was in place. On October 15, CMS described the held claims: "This includes all claims paid under the Medicare Physician Fee Schedule, ground ambulance transport claims, and all Federally Qualified Health Center claims." Home health claims are not on that list. On October 21, CMS lifted most of that hold but kept holding some telehealth claims and "acute Hospital Care at Home claims." Afterward, CMS summed it up: "During the shutdown, in general, the Medicare Administrative Contractors (MACs) processed claims consistent with the pricer software, fee, and payment schedules available on cms.gov."

This December is different. The stopgap ends December 11; the telehealth extension runs to the end of 2027. A lapse with no Medicare provision expiring that day lacks the trigger for the October 2025 hold. That is a reading of CMS's stated practice, not a CMS promise.

The 14-Day Floor and the 30-Day Clock

Section 1816(c) of the Social Security Act sets both edges of the Part A payment window, in the statute rather than the spending bill.

• The floor. Section 1816(c)(3)(A): "no payment shall be issued, mailed, or otherwise transmitted with respect to any claim submitted under this subchapter within the applicable number of calendar days after the date on which the claim is received." That number is "13 days" for electronic claims and "28 days" for the rest. CMS calls this the "14-day payment floor" and says a short hold "should have a minimal impact on providers" because of it.
• The ceiling. Section 1816(c)(2) requires payment of "not less than 95 percent of all claims" that are clean claims within "30 calendar days." Section 1816(c)(2)(C) names home health agencies and says that when a clean claim is not paid in time, "interest shall be paid."

What Does Stop: Surveys and Certification

The FY 2026 CMS plan names survey and certification as the work that stops. Survey work "would focus on complaint investigations alleging the most serious incidents of resident or patient harm," and "recertification surveys ..., initial surveys, less serious complaint investigations, and federal monitoring surveys would be suspended until funding is restored."

CMS's October 2025 memo to state survey agencies, QSO-26-01-ALL, spelled out what that meant.

The agency that feels a lapse is the one waiting on a first certification, a sale, or a move.

When funding came back, the recovery memo, QSO-26-02-ALL, told states: "States should resume all activities suspended during the shutdown."

The Extenders: What Is Actually on the Clock

The telehealth flexibilities and the hospital-at-home waiver live in the Consolidated Appropriations Act, 2026, Public Law 119-75, approved February 3, 2026.

• Telehealth, section 6209. The flexibilities that read "ending on January 30, 2026" now read "ending on December 31, 2027." The in-person requirement for mental health telehealth moved to "on or after January 1, 2028."
• Acute Hospital Care at Home, section 6210. The waiver date moved from "January 30, 2026" to "September 30, 2030."

The home health piece is the face-to-face encounter. Under 42 CFR 424.22(a)(1)(v)(B), "The face-to-face patient encounter may occur through telehealth, in compliance with section 1834(m) of the Act." Section 1834(m)(4)(C)(iii), as amended, counts any site where the patient is, "including the home of an individual," as an originating site for the period "ending on December 31, 2027." A December 11 lapse does not touch that date.

The same law's Medicare title also has items that end with 2026, shown here with the two dates above.

Whether any of the year-end items rides on the next funding bill is up to Congress. None of them is a home health payment provision. If one expires January 1, the October 2025 pattern points to a hold on the claim types tied to it.

What to Do Before December 11

Practice, not rule:

• Keep billing on the normal cycle. CMS's own words during a hold: "Providers may continue to submit claims during this period, but payment will not be released until the hold is lifted."
• Push any pending certification action now. In October 2025, initial certifications, changes of ownership and changes of location waited for funding.
• Watch MLN Connects and your MAC's news page the week of December 11. CMS posted each October 2025 change there.
• Hold some cash for a delay anyway. No FY 2027 plan is posted, and the last two differed.
• Keep a lapse separate from rates. In October 2025, MACs priced claims on the published payment schedules. Your 2027 numbers come from the CY 2027 home health rule and your HHVBP adjustment. For how a 30-day period is priced, see how CMS pays home health.

Key Takeaways

• December 11, 2026 is when the current stopgap ends unless Congress acts. As of October 7, 2026, nothing has replaced it.
• Medicare pays from trust funds, and CMS's lapse plan says the Medicare program continues. In the October 2025 shutdown, MACs kept processing and paying fee-for-service claims.
• Claims holds come from expiring payment provisions, not from the lapse itself. The claim types CMS named as held in October 2025 did not include home health.
• What stops is survey and certification: home health recertification surveys, initial certifications, changes of ownership and changes of location.
• Telehealth flexibilities, including the home as an originating site for the face-to-face encounter, run through December 31, 2027. The Medicare items ending with 2026 are hospital, physician, Part D and hospice survey provisions.

Frequently asked questions

Will Medicare still pay home health claims during a government shutdown?

Based on CMS's own plan and what it did in the last long shutdown, yes. The CMS contingency staffing plan says the Medicare program will continue during a lapse in appropriations. In October 2025, CMS told providers that MACs will continue to perform all functions related to Medicare fee-for-service claims processing and payment.

When does the current continuing resolution expire?

Public Law 119-103, the Continuing Appropriations and Extensions Act, 2027, was signed September 2, 2026. Section 106 keeps funding available until a full-year bill replaces it or December 11, 2026, whichever comes first. As of October 7, 2026, nothing has replaced it.

Does the December 11 deadline end the Medicare telehealth flexibilities?

No. The September stopgap does not mention telehealth. The Consolidated Appropriations Act, 2026 extended the telehealth flexibilities through December 31, 2027 and the Acute Hospital Care at Home waiver through September 30, 2030. For home health, the patient's home stays a telehealth originating site for the face-to-face encounter through December 31, 2027.

What is the 14-day payment floor?

Section 1816(c)(3) of the Social Security Act bars payment of a Part A claim within 13 days of receipt if it was sent electronically, or 28 days if it was sent on paper. CMS calls this the 14-day payment floor, and says it is why a short claims hold should have a minimal impact on providers.

Will state surveys of home health agencies continue during a shutdown?

Only the urgent ones, if CMS repeats its October 2025 instructions. That memo told state survey agencies that no Medicare-funded recertification surveys of home health agencies would be performed, and that initial certifications, changes of ownership and changes of location would wait for funding. Complaints alleging immediate jeopardy or actual harm were still investigated.

Sources

• Public Law 119-103, Continuing Appropriations and Extensions Act, 2027 (H.R. 6500, approved September 2, 2026), sections 106 and 2007. Enrolled text also at congress.gov.
• Public Law 119-75, Consolidated Appropriations Act, 2026 (approved February 3, 2026), division B (grants to states for Medicaid) and division J, sections 6201, 6202, 6207, 6208, 6209, 6210 and 6217.
• HHS, FY 2026 CMS Contingency Staffing Plan and FY 2025 CMS plan; FY 2026 HHS Contingency Staffing Plan; Contingency Staffing Plan index.
• CMS, MLN Connects special editions: October 1, 2025, October 15, 2025, October 21, 2025, November 21, 2025. CGS repost of the October 1 notice: cgsmedicare.com.
• CMS, QSO-26-01-ALL REVISED, survey and certification during a federal government shutdown (October 21, 2025), and QSO-26-02-ALL, recovery after the shutdown (November 24, 2025).
• Social Security Act section 1816(c), 42 U.S.C. 1395h; section 1817(h), 42 U.S.C. 1395i; section 1841(g), 42 U.S.C. 1395t; section 1834(m), 42 U.S.C. 1395m.
• 42 CFR 424.22(a)(1)(v)(B): the face-to-face encounter through telehealth.
• Related on this site: CY 2027 home health proposed rule, HHVBP annual performance report, how CMS pays home health in 2026.