Summary
In this episode of Carelab, Brandy Archie and Emelia discuss how the U.S. government shutdown affects healthcare access—particularly telehealth and home health services. They explain how the temporary nature of Medicare’s telehealth reimbursement has left patients and providers uncertain, and how proposed cuts to home health funding could further strain care delivery for older adults and people recovering at home. The hosts emphasize the importance of understanding these policy changes, advocating for continued support, and using one’s voice to influence legislators and CMS decisions.
Key Questions Answered
-
What happens to telehealth services during the government shutdown?
When the government shut down, Medicare’s temporary telehealth reimbursement expired. This means providers might not get paid for telehealth visits, and those costs could end up being billed to patients. -
Why is telehealth important to maintain?
Telehealth increases healthcare access for people with mobility challenges, rural residents, caregivers juggling multiple appointments, and families needing quick virtual consultations. It helps reduce stress, travel time, and overall healthcare barriers. -
What is home health and who benefits from it?
Home health provides skilled nursing and therapy at home for patients recovering from surgery, illness, or hospitalization—especially those who are homebound. It helps people regain independence safely within their living environments. -
How could proposed cuts to home health spending affect care?
A proposed $1 billion reduction to home health reimbursement would likely result in fewer visits, rushed care, and decreased access—hurting patients who depend on consistent in-home support to recover. -
What can people do to protect these healthcare services?
Citizens can contact their legislators, submit comments to CMS, and advocate for making telehealth coverage permanent while opposing cuts that would limit home health services.
Transcript
CareLab Podcast
Hey there, welcome to Care Lab.
Brandy Archie
Welcome to Care Lab everybody. We are recording a special episode with just me and Emelia because a lot is happening in America right now. And because at the moment that we're recording, the government is shut down and there are actually a lot of healthcare implications around that. And so today we wanted to talk about what you can expect now, what you should think about for the future and the potential changes that are coming and how that might impact your ability to provide care or to get your own healthcare. So...
Should we get started?
CareLab Podcast
Let's get started. Let's stick right in. And I think first, you wanted to talk about telehealth, right?
Brandy Archie
Yeah, telehealth. So, okay, I'm gonna give y'all a small history about telehealth. We have been using it for at least the past five years, but prior to COVID, telehealth was not reimbursable by Medicare. And so in almost all situations. And then of course COVID happened and we needed to be able to provide care to people without necessarily being in front of them. And so they passed a temporary measure to allow for telehealth under certain conditions.
to be reimbursable service by Medicare. And this whole time since then, it's been a temporary measure and we've all gotten used to using it. We've had lots of studies and research that shows that it's effective and everybody likes to use it. And it also stretches our healthcare system that's already like not big enough, if that makes sense, or doesn't have enough providers and enough time to provide services. And so what's happened though is because
It continues to get added into other legislation as a temporary measure and kind of like a bargaining chip really depending on who's doing what. It has never turned into actual law. And so the can has gotten kicked down the road all the way to a point at which has come to a head now, which is September the 30th. And because we didn't pass a budget and the government has shut down,
No more kicking of the can has happened. So as of October the 1st, Medicare is technically not reimbursing for telehealth visits. Emelia, what is the first thing you think about when you hear that?
CareLab Podcast
Well, there are a lot of things that I think about when I hear that. But one is that we've become really reliant on telehealth and also that telehealth is really, really great for people. Obviously, it's not appropriate for every situation. And providers, by and large, are really good at navigating what situations are or are not appropriate for telehealth. But it's a really important way that people who would traditionally have less access to health care
have been able to get more equity and access in healthcare, specifically thinking about rural communities, people who have more trouble with mobility, people who might be lower income or people who might just have more trouble getting to and from a doctor's appointment for any kind of reason. so telehealth has really, really been very positive for healthcare. And the idea that it...
may not be funded raises a lot of questions about how we move forward. Like all these telehealth visits that are probably still taking place right now, are they gonna get paid for? Who's gonna pay for them?
Brandy Archie
So this is the challenge. so first, guess I should say, getting, I said that Medicaid doesn't reimburse for them, which means they're not paying the provider for them. So if the provider's not getting paid, that bill is gonna come to the patient. And so, and you're not expecting that, because especially if you've been continuously using telehealth as your primary way of accessing certain kinds of doctors.
you're used to either paying your copay or not having to pay anything. And so now that bill might come back to you. And so everything is a might at this point, which is what's really challenging about this because Medicare has paused reimbursement on telehealth because, we've had government shutdowns before and sometimes they don't last very long. And like the wheels of government, all the things we do grow, you know, they're hard to start and stop. And so Medicare is like, OK, well, maybe this will end quickly and
CareLab Podcast
Mm-hmm.
Brandy Archie
They'll re-up the telehealth thing or maybe make it permanent for us and we'll just process those payments. So they're leaving the door open for that. But also if it doesn't happen soon or maybe it never happens or at some point nobody takes up the mantle to turn telehealth reimbursement into a permanent benefit, then they have the full right to say these are not getting covered because the law says they're only covered temporarily till September 30th, which has already passed.
And so then it's gonna be on your provider to probably come back to you and say, hey, you owe us for this visit because your insurance didn't cover it. Because that's how we do other things, right? Like you do the best job you can to check to see if your insurance is gonna cover a thing. You go do a thing. And in some cases they might say, yeah, we're not covering it. That bill comes back to you. Even if you did your best due diligence to see that it was gonna get covered. And so depending on how long this goes,
CareLab Podcast
Mm-hmm.
Brandy Archie
I can't see every provider eating all of those costs and not sending bills out.
CareLab Podcast
Yeah, for sure. It just makes up too much of the operating budget probably for some of these practices and for hospitals and clinics and all kinds of healthcare providers, right? Yeah, that's, I mean, and I think the thing that's really, it's like, it's just a question mark. We just don't know. So it's like,
Brandy Archie
Yeah.
CareLab Podcast
If you have telehealth, should you cancel the appointment? If you're a provider, how do you navigate the system? All these unknowns just make it really hard. And of course, what everyone wants is just to get good healthcare and deliver good healthcare. If you're someone who needs healthcare, which by the way, is all of us, we all need healthcare, you just want to get it. You want it to get it as conveniently and as easily as possible. And if you're a provider of healthcare,
Brandy Archie
Right.
CareLab Podcast
Believe it or not, we actually want to do the best job that we can to provide it as well. So yeah, this big question mark is a big problem.
Brandy Archie
And the other thing I think about when I think about telehealth is like...
I think it was first billed as like, this is a need for the rural community. I'm not saying it's not, it is. But since we've been using it for the past five years, we've recognized there's plenty of other people who benefit from it. And you did a good job of listing out the reasons. And I just want to like personify that some. So yes, if you can't drive, if it's takes you 45 minutes to drive into some clinic and that thing can be, and you're going to be there for 10 minutes and have to drive back and that thing can be done via telehealth. Yes, let's do that. But also what if you've had a stroke and you're
driving and therefore you need to catch public transportation or accessibility transportation either way. They pick you up an hour early, they take you in there, you're doing your therapy for three hours or however long you're there for and then they pick you up an hour late and take you home and like how much energy do you have left to like do regular everyday stuff and what do we know about stroke rehab? You need repetition in order to improve and if you used all your reps are really just in therapy and you
CareLab Podcast
Mm-hmm.
Brandy Archie
do nothing else because it took you so much effort to get there and get back, like that's reversing what we're trying to have accomplished. And, you know, so that's just like an example from the mobility side of things. And then like, what if you have multiple kinds of visits that you need to, you know, to have in a short amount of time and you can't get to all those places, you're not driving, you gotta ask somebody to help you get there.
the timing's not working out because you gotta see this doctor cross-tied over here and this doctor over here and they don't have any more visits for six months.
It's serving a really big need for a lot of different people, not just people who are living outside the city.
CareLab Podcast
Yeah, that's a great point. I want to take the caregiver perspective on that too. If you are a caregiver and you're responsible for getting someone to and from all of their doctor's appointments, and let's be honest, that can be a lot of appointments. Maybe they need to see their cardiologist one day, their pulmonologist another day, their primary care doctor, a neurologist, the kidney doctor, they got to go to dialysis. Obviously we can't do dialysis telehealth, but...
Brandy Archie
Mm-hmm.
CareLab Podcast
point being, are there some of those visits that could be done via telehealth that would save both your mind and your body and your day, the time and the energy and the effort that it can take to get someone into the car who maybe does have a mobility issue? Anyone out there who's ever helped a stroke survivor?
who doesn't have full mobility transfer in and out of the car, you know what I'm talking about, right? But there are all kinds of things that can go along with this. So if you have a dozen appointments in a week that you have to get to, that could literally take almost every second of your whole week. Cause you also have to, you gotta get that person ready early. That takes time. You gotta make sure that you are, that they eat their breakfast, that they're ready to go, however many times.
Brandy Archie
Yes.
Brandy Archie
every day all day.
CareLab Podcast
hours or whatever before the appointment, you gotta get there. This could literally be your entire life for a week trying to get to all of those appointments. What if you could do half of those via telehealth? How much stress would that relieve? And that's one of the things that telehealth has really been able to accomplish for people as well. And when we kind of throw it, so again, this is a really beneficial thing we all use. I use telehealth all the time. One of my kids is sick. I don't think they're dying.
Brandy Archie
Mm-hmm.
CareLab Podcast
But, know, they need something. I'll do a telehealth visit, right? If we're not able to get into the doctor, if the doctor doesn't have an appointment right then and there, I'll do the same thing for myself. So we all benefit from this. And yeah, it's a shame that we haven't made it permanent yet. And it's really a shame that we're in the situation where we just don't know what's gonna happen. And if people are gonna get the care that they need, if they're not gonna get the care they need,
Brandy Archie
They need some they need some eyes on them
Brandy Archie
Yeah.
CareLab Podcast
and how much that's going to cost.
Brandy Archie
Totally. So what else is maybe affecting us at this moment, either because of the shutdown or because of the changes in government that we should talk about?
CareLab Podcast
So I just heard yesterday, obviously there's lots of things going on, but I just heard yesterday and I'm gonna be totally transparent. I'm not the most well-versed on this proposed rule change. Like I don't wanna, but I just found out yesterday and I started looking into it that there is a proposed cut to home health spending for 2026, which would amount to a little over a billion dollars.
Brandy Archie
Sure.
CareLab Podcast
And the idea around it, as I understand it, is that they're trying to kind of essentially go back and collect back money from payments that are now perceived to have been overpayments from the past between like 2020 and 2025. That's how I'm understanding it. So let's talk about home health. And yeah.
I'll let you just, why don't you, cause you let me start talking about why telehealth is great. Let's talk about why home health is actually really great.
Brandy Archie
Yeah, okay, so first let's define home health. Home health is this service that is skilled and is covered by your insurance so that when you leave from the hospital and you go home and you still need nursing care or physical or occupational therapy or speech therapy that you can, but you're having a hard time getting out to go get that, which is called being home bound, then you can have those therapists, those clinicians come to you and provide you the care you need.
in order to improve your status so that you either don't need any more care or that you're well enough to not be homebound and therefore can go out and get your outpatient care where you would normally get it at. And so this is super key, especially after surgery. There's lots of reasons, lots of reasons to use Home Health, but like one of the ones that like stands out the most is like hip and knee replacements, right? You have a hip replacement. Now you have these new restrictions of not being able to bend and
not do these movements, plus you have all this pain. You might have stairs, especially if live in Kansas City, you gotta split up a house, you got all these stairs to deal with. And if you can't manage that for the first few weeks of your recovery, you could just stay in the house, but also you have a wound that needs to be addressed and make sure that, like a surgical incision I should say.
that needs somebody to look at it and really can't keep that bandage on for two or three weeks until you feel like you can get out the house, you need some care in order to make sure that this surgery does not fail. And so you want to be able to have access to somebody to come into your home and to provide you the care and rehabilitation that you need. Plus, home health is to me, or I should say care in the home is the best place to provide occupational therapy because our job is to help make sure you can be safe and independent and take care of yourself.
CareLab Podcast
Mm-hmm.
CareLab Podcast
Mm-hmm.
Mm-hmm.
Brandy Archie
And that first starts at home. And so in all the other places we do OT, which are great and awesome, we're really just trying to make up the situation that happens at home. And so when we can just be in the home, then we can just help you straight away, right? In a much more intimate way than we can do in acute care or other studies that are away from your house. So that's what home health is and a strategic benefit to everybody involved.
CareLab Podcast
Mm-hmm.
CareLab Podcast
Yeah, and I would say like, yes, absolutely, especially because we think so much about the environment as occupational therapists and the environment that people are trying to do the things they want to do in. Home health is a really, really important thing for OT to be involved in. But for almost every discipline that's involved, just seeing the place where the person that you're caring for is trying to do their things, it helps you to know what barriers is this person up against.
Brandy Archie
Exactly.
CareLab Podcast
A lot of times maybe there's a simple fix for how we can actually make things a lot better or a lot easier or cleaner or safer, whatever it is that that person needs. And there's a lot that we miss when we don't, when we're not able to see people in the places that they call home, right? But yeah, there are all kinds of reasons why people might be getting home health because they're home bound. And it is a really, really important aspect of care. Now, as you and I were talking about earlier, back in the day, was there some abuse in the system?
Do people get seen too long? Yeah. Like that definitely happened. But I can't remember how many years ago. Do you remember how many years ago it was?
Brandy Archie
that they changed the payment structure for home health.
CareLab Podcast
Mm-hmm. Yeah, so let's talk about how the payment structure kind of works for home health right now and why visits are now really, really limited, almost to the point where you actually can't even see someone as long as you need to as a home health provider.
Brandy Archie
need to. Yeah. Okay, so I'm not gonna say originally, but.
years ago, at least 10 years ago, we were getting billed for every visit that we did. And so if an OT came three times a week and a PT came three times a week and a nurse came two times a week, the home health company was billing for each of those visits until everybody decided that you were well enough or not home bound enough or not home bound anymore and went about your way. And so that left enough room for some level of
waste in which maybe they didn't need to do that many visits because the home health company is benefiting from the more time somebody shows up, right? Okay, so then at least five years ago and don't quote me on the timeframe, but it's been a good amount of time. They changed the model so that based on what kind of diagnosis, maybe multiple diagnoses a person has, CMS has the data to show that like on average somebody with
CareLab Podcast
Mm-hmm.
Brandy Archie
this diagnosis needs about this much care before they're not homebound based on all the stats from before, which is fairly reliable. And they use that to help figure out, we're gonna pay you this bundle of money, which we think should last you XYZ days because the average person with your condition needs XYZ days. And that's how we're gonna pay you, home health company. So now the home health company is incentivized.
to get you in and out quicker. And on some level, that definitely decrease waste. But on other hand, if somebody doesn't code your situation right, or something new shows up as you're working from home or working out of the home, or you have a really challenging home setup, because the diagnosis code does not take into account what your environment is or how much help you have.
CareLab Podcast
Mm-hmm.
Brandy Archie
then you might actually need more care if you're living alone in a house with multiple stairs and you need to be independent, not just like contact guard or sister helping, because you'll have helper. And so there's some level of variability that those numbers don't take into account. And so sometimes people don't get as much care as they should get now that we have this packaged pay payment model.
CareLab Podcast
Mm-hmm.
Yeah, because essentially the incentive goes the other way now is to actually give people the minimum amount of care that they possibly need and then kind of move on because you're only getting paid so much for this. Wouldn't it be nice to live in a perfect world where people just got the care that they need and we didn't have to think about it beyond that. Like we could just take care of people and do what they needed and then let them go on their way.
Brandy Archie
got the care I needed? That would be so nice.
Brandy Archie
Mm-hmm.
CareLab Podcast
Okay, but of course that's not the perfect world that we live in right now. So let's talk about what what this could look like if we cut a billion dollars from the home health system, which at this point, at least I feel it's already hard to see people as much as they need to be seen.
Brandy Archie
Yeah, well, hold on. Let's connect the dots, because I don't think we made the bridge all the way. So the reason that they're the reason they're giving for having this decrease in reimbursement is that they want to cut out fraud, waste and abuse. And they want to they they went retroactively over the past five years to see how much was spent basically. And they you mentioned this word perceive that more was done than was needed.
CareLab Podcast
Okay. Gotcha.
Brandy Archie
And we also know we had COVID in there too, which changed a lot of scenarios in a way that we don't have data on. We have now, but we didn't to compare it to. And even though the things have changed in a way that people get far less care and oftentimes not as much care as they should have, they're still wanting to cut more out of that system. So now the proposed rule is that we're going to decrease reimburses by a billion dollars next year.
CareLab Podcast
Mm-hmm.
Brandy Archie
And so what does that end up looking like?
CareLab Podcast
Well, it ends up looking like less care, right? Because if you have less funding, then you will get less care. And, you know, so I think that it's really important to understand that about almost 20 % of our country is covered by Medicare. Another 20 % of our country is covered by Medicaid. So altogether, that's 40 % of our country.
where people are being taken care of under, you know, CMS rules. So what's the real upshot here? What do we need to do? Well, we need to know what's going on, get informed. We need to understand how it's going to affect us. We need to ask lots of questions. We need to call our legislators and say like, hey, you know, this isn't, maybe this doesn't affect me right now, but affects my mom, affects my dad. It affects, is, it's likely that this is going to affect someone you know.
Brandy Archie
Mm-hmm
CareLab Podcast
right? Because so much of the country is covered by Medicare or Medicaid, right? So again, what can you do? You can try and get informed. You can ask questions of your senators, of your legislators. you can call you as these things have not necessarily been done yet, right? Like we have power as citizens to say what we want. So
Brandy Archie
Yeah.
CareLab Podcast
You know, we got to use our voices and whatever you, whatever you look at, whatever you think, whatever you agree or disagree with, using your voice to make sure that the people who represent you know what's important to you is just a really important part of being an American.
Brandy Archie
And I think this is true for both things. Even though telehealth is already on pause, an official rule one way or another hasn't happened. So we should be saying, like, hey, I use telehealth XYZ amount, and I really want to make sure that continues to be covered. Here's what you should know about that. It's coming as a constituent, either to your legislature, or you also can make direct, I'm going to pause, your vibration, I can hear.
CareLab Podcast
Mm.
CareLab Podcast
I literally turn everything off and then it's still stop it.
CareLab Podcast
Okay, all right, okay.
Brandy Archie
I'm going to go back to where I can remember, which is in both of these cases, telehealth and the cuts, the proposed cuts to home health, none of it is like official yet.
So for telehealth, it's on pause and we need to make an official rule that says it's going to be covered if we want to keep having it. And for the cuts, those are proposed rule changes for next year. So both have the ability to be changed. And so that's why it's really important that we're not only talking to our legislators about it, but CMS itself, both of these are CMS issues. CMS itself allows for open comment as well. And so you can make a comment directly to them about your concerns about it.
CareLab Podcast
All right, well, if there are other topics that you are interested in that you want us to explore or talk about the possible implications of, we'd be happy to do that. Please make sure to leave a question, a review, a comment, and we're happy to take a look at those things for you or bring in a guest who can talk about those things as well. If you made it to the end of this episode, thank you so much for listening. We'll see you next week right back here on Care Lab.
Brandy Archie
Bye, everybody.
Do us a favor and subscribe to the CareLab podcast on YouTube, Spotify or Apple Podcasts! It will help others find our conversations and grow the community and you’ll stay updated with the latest insights and expert advice on elder care.
