Supporting Patients and Healthcare Providers Through a Government Shutdown 

By Kathy Pendergrass

 

On October 1, 2025, the federal government entered a shutdown while Congress continues its funding battle. While many federal healthcare programs remain stable in the short term, prolonged disruption could impact operations and patient access. AssistRx is closely monitoring the government shutdown to help life sciences organizations guide patients and healthcare providers (HCPs) through this time of uncertainty.

What You Need to Know:

Short-term Operations Remain Stable

For now, Medicare and Marketplace operations remain largely unaffected, as funding is built into law through 2025 and the beginning of 2026. Coverage, Open Enrollment and HCP payments continue, and both Medicare.gov and Healthcare.gov are fully operational. The Centers for Medicare & Medicaid Services (CMS) updated the Medicare Plan Finder with 2026 plan information prior to the government shutdown, but Medicare.gov now includes a disclaimer that updates to information on the website may be limited or delayed. Importantly, Medicare.gov reassures patients that benefits and coverage will continue as before, and patients can still access needed care.

Reduced Staffing May Increase Wait Times

However, reduced staffing at the CMS during the shutdown is likely to cause longer wait times and delays to certain processes. Medical benefit verifications (BVs) requiring manual outreach to Medicare Administrative Contractors (MAC) may be impacted, requiring patient support program providers to proactively adjust processes to ensure timely BV returns.

Social Security, SSI (Supplemental Security Income) and SSDI (Social Security Disability Insurance) payments will also continue, though applicants may experience delays in processing Low-Income Subsidy (LIS) applications and extended hold times when contacting representatives — as we may see 50% of phone staff get furloughed.

Beyond longer wait times, reduced staffing may also cause less oversight on Medicare Plan enrollments. Correcting misinformation and enrollment errors caused by less oversight in the short term could result in long-term delays even after the government shutdown ends.

Medicare Telehealth Flexibilities Expire

One other notable risk is the expiration of Medicare’s telehealth flexibilities which lapsed on the same day the government shutdown began. This program has been essential in expanding care access to homebound seniors, and risks remaining expired unless Congress includes funding in its spending bill.

Supplemental Benefits Shortfalls Could Affect Adherence

Medicaid coverage and payments are expected to continue during the shutdown. However, supplemental benefits tied to food, energy or housing assistance may face funding shortfalls. About 30% of Americans report not taking their medicines as prescribed because of cost — and although most Medicaid enrollees pay little to no copay for prescriptions, financial strain in other areas could still affect therapy adherence for some patients if household resources become limited.

To bridge this gap, patient support programs utilizing foundational support assistance solutions may refer or warm transfer patients to charitable foundations. This ensures patients continue access to necessities while the shutdown persists and can continue their therapy regimens without disruption.

What to Expect Next:

In short, the ultimate impact depends on the shutdown’s duration:

• • Short-term (<1 week): Minimal disruptions, primarily longer wait times.

• • Several weeks: Delays in regulatory processes and potential backlogs.

• • Extended shutdowns: Greater risks to government program oversight and regulatory timelines. Once legislative payment provisions are set to expire, CMS may direct all MACs to implement a temporary hold on Part A, B and DME claims payment.

The AssistRx Difference

In a rapidly changing space, it’s critical to have a partner that stays ahead of market dynamics and provides proactive consultation on patient support program evolution and optimization. As federal policies evolve, AssistRx combines our specialty pharmaceutical expertise with real-time, actionable insights that help life sciences organizations best support patients and HCPs during times of uncertainty. Our proactive approach ensures therapy access and patient support continue during disruptive events such as a government shutdown.

Stay informed with the latest updates and guidance by connecting with our team.