How the 2025 Government Shutdown Affects Your End-of-Life Care

As the government shutdown enters its tenth day, you might be wondering how this is going to impact patient-directed care at the end of life. We’ve got you covered! Here are some answers to people’s most pressing questions about what this means for your end-of-life options. 

What is happening with the government shutdown anyway? 

Every Congress, both the House of Representatives and the Senate have to pass a bill to fund government services. On October 1, 2025, the Republican-led House of Representatives and Senate were unable to secure the votes needed to continue to fund the government, even in the short term. The Senate on Monday again rejected Democratic and Republican proposals to fund the government and end the shutdown. The Democrats’ proposal failed by a 45-55 vote and the Republican bill failed by a 52-42 vote. Both needed 60 votes to pass.

The House won’t return to session to vote on anything this week, according to Speaker Mike Johnson. 

President Donald Trump’s administration is warning of no guaranteed back pay for federal workers during a government shutdown, reversing what has been longstanding, multi-decade policy for some 750,000 furloughed employees, according to a memo being circulated by the White House. This includes employees who work on end-of-life care related initiatives at the US Department of Health and Human Services, US Department of Veterans Affairs, and Centers for Medicare and Medicaid Services (CMS). 

The D.C. Death with Dignity Act remains in effect and unimpacted. No federal funds are used to implement D.C.’s Death with Dignity law.  

How does this affect my access to healthcare? 

Some agencies — including the Centers for Medicare and Medicaid (CMS) — will continue to provide essential services, albeit with a reduced staff. That means during this funding lapse, Medicare, as well as Medicaid programs and services, will continue, according to the latest CMS contingency plan. However, about 49% of CMS staff will be furloughed, and certain services are paused during a shutdown. This could lead to longer wait times to speak with a CMS representative, which means if you need to enroll for new services, ask questions or get approvals, it will take longer than usual. 

In most states, bar a few exceptions, the open enrollment period begins at the start of November for Affordable Care Act (ACA) plans.

ACA marketplaces are “supported by insurance company user fees, so they can remain operational during government shut downs.”

However, following the signing in July of a budget reconciliation bill that made deep cuts to Medicaid funding, lawmakers from both sides of the aisle have raised concerns about looming increases in the cost of health care. Enhanced subsidies for health insurance via Affordable Care Act exchanges are set to expire by the end of this year, leaving Congress with little time to negotiate an extension and avoid an increase in the cost of insurance, estimated at 75% for the average premium (or $700 per year).

What impacts does this have specifically on end-of-life care? 

While this will not affect access to medical aid in dying in authorized states and jurisdictions, one of the biggest impacts the shutdown will have on end-of-life care is access to telehealth appointments. Congress was not able to agree on an extension of these critical rules before the shutdown went into effect. Now, improvements introduced during COVID that allowed hospice and other healthcare providers to use telehealth stopped with the end of the government’s fiscal year on September 30, 2025. These changes not only impact the way healthcare providers support their patients but impact WHO is able to receive care, since geographic requirements are now back in place. During the shutdown, certain services, which expired on Sept. 30, will no longer be available to Medicare recipients. Patients can no longer receive telehealth from home unless they meet specific criteria; telehealth flexibility will again be limited to rural areas; audio-only visits will no longer be reimbursed for most services; and physical therapists, occupational therapists, speech-language pathologists and audiologists will be excluded from telehealth reimbursement. As a result, providers are now uncertain whether telehealth services delivered during the lapse will be reimbursed retroactively and some are refraining from submitting telehealth claims until Congress passes a budget.

Telehealth also allows for rapid response to patients in crisis – which is a common concern for people in the final phase of life. For example, allowing a provider to conduct a telehealth visit for someone with an urgent need means the difference between minutes for a video call to connect versus potentially hours for the provider to be available in person and drive to the patient’s home.

Using virtual care in combination with in-person visits allows healthcare providers the flexibility they need to efficiently and effectively support their patients.

The use of telehealth in healthcare has now been rolled back to the pre-pandemic era, meaning that expanded access is no longer available. 

Advocates and organizations like the American Telemedicine Association and the Center for Connected Health Policy have said this could impact some of the most vulnerable populations in the U.S., including millions of seniors who rely on telehealth for chronic care, mental health and post-operative check-ins, those with disabilities, or people living in underserved areas who face physical limitations to accessing in-person care.

In addition to the wide-reaching impact of telehealth on end-of-life care access nationwide, the shutdown also ended innovative programs such as the Acute Hospital Care at Home (AHCAH) program, that allowed people to receive care at home and avoid going to the hospital. For all hospitals participating in this program (400+ nationwide across 39 states), patients will either have to return to the hospital or end their at-home services.

At Compassion & Choices, we’re working to advocate at every level of government nationwide to ensure your rights are accessible, protected and defended from attack.

Will you donate today to make sure we have the resources to continue advocating for your care?

This is an evolving situation and we are monitoring closely as it unfolds. We will continue to keep you informed as information develops.