Impact of Potential Federal Government Shutdown on Medicare Payments, Including  the Temporary Aad-ons for Ground Ambulance Services

The federal government is funded through annual appropriations enacted by Congress.  Funding for the federal government’s current fiscal year is currently set to expire today, September 30, 2025.  If Congress fails to pass a spending package for the full year – – or a temporary funding package for a shorter period (known as a “continuing resolution”) – – many federal agencies will have to curtail their activities.  On September 18, 2025, the House of Representatives passed a continuing resolution that would have funded the federal government through November 21, 2025; however, that bill failed to pass the Senate.  As a result, barring a last-minute deal, a federal government shutdown will commence on October 1, 2025.

A government shutdown is not expected to impact Medicare payments to health care providers, i.e., Medicare Administrative Contractors will continue to process and pay Medicare claims.  However, past government shutdowns have impacted other Medicare operations, including provider enrollment and pre- and post-payment audit activities.  Providers that are currently in the process of enrolling and/or revalidating their Medicare enrollment may experience delays in the processing of these applications.

As a reminder, existing law requires that Medicare Administrative Contractors hold claims for a minimum of fourteen (14) days.  This “payment floor” would provide a bit of breathing room in the event of a relatively short federal shutdown.  If, however, a shutdown continues for longer than 2 weeks, it is likely that Medicare contractors would be forced to pay ambulance claims with dates of service on or after October 1, 2025 at the statutorily required amount (i.e., an amount that does not take into account the current add-ons).  If the spending deal to reopen the government includes the retroactive extension of those add-ons, the MACs would need to subsequently adjust any payments made at that lower amount.  There is precedent for such retroactive adjustments.  Of course, the current hope is that a deal can be reached early enough to avoid the need for any retroactive adjustments.

Thus, while Medicare payments for ambulance services will continue without interruption, the payment amounts will be impacted.  This is because the temporary add-ons for ground ambulance services (i.e., the 2% urban, 3% rural, and super-rural bonuses) are currently set to expire on September 30, 2025.  The hope is that any deal to avert a shutdown and/or to reopen the government after any potential shutdown will include an extension of these critical add-ons.

The American Ambulance Association is monitoring the situation closely, and will continue to keep our members updated as new information become available.