It’s Time to End Stopgap Health Care Policy
12/1/2025
This article first appeared as a column in the 2025 December issue of South Florida Hospital News
By Mary Mayhew, FHA President and CEO
The short-term federal funding bill enacted last month reopened the federal government after the longest government shutdown on record. It also provided much-needed relief for hospitals and the patients and communities they serve.
The bill extended until January 30, 2026, vital health care programs, from telehealth and hospital-at-home to Medicare-dependent and low-volume designations for rural hospitals. It also restarted the moratorium on cuts to Medicaid disproportionate share hospital (DSH) payments.
That’s the good news.
The challenge now is to avoid additional disruptions to hospital planning and care delivery by extending the rural hospital designations for a longer term, providing long-term relief from Medicaid DSH cuts, and making hospital-at-home and telehealth permanent health care policy. January 30 will be here before we know it, and the persistent threat of expirations and the need for additional short-term extensions are not conducive to health care stability and reliability.
Predictability, reliability, and continuity of care are at stake.
Rural Hospital Designations
Low-volume and Medicare-dependent designations help compensate for rural hospitals’ very real patient demographic differences. Rural residents are often older, have lower incomes, and have higher rates of chronic illness, making Medicare rural hospitals’ predominant payer. With Medicare covering only about 82 percent of hospital costs, on average, the enhanced payments made possible with the low-volume and Medicare-dependent designations help protect rural hospitals’ financial viability and, most importantly, their ability to provide care in their communities.
Short-term extensions and the continued threat of expiration of these designations put rural hospitals in an uncertain position that makes long-term financial planning more difficult and starves them of essential resources.
Telehealth and Hospital-at-Home
Similarly, cycles of momentum and shutdown for telehealth and hospital-at-home programs are not conducive to stable hospital operations, and hospitals, clinicians, and patients alike should be able to trust that these programs are reliable, dependable, and available when they need them.
Hospital-at-home and telehealth programs form the fabric of a modern health care delivery system, one that is innovative, agile, and patient-friendly. Nearly 420 hospitals across 39 states, including more than 40 hospitals in Florida, have federal approval for a hospital-at-home program. Originally a pandemic-driven necessity, they have since proven their value and effectiveness over and over again at extending hospitals’ inpatient capacity, reducing emergency department boarding, and delivering clinically excellent care in patients’ familiar environments.
Hospital-at-home patients generally have lower mortality rates, readmission rates, and spending in the 30 days post-discharge, compared with traditional inpatients, according to data from the Centers for Medicare & Medicaid Services. Patients and caregivers also express predominantly positive experiences with the program.
Telehealth programs eliminate traditional access-to-care barriers, such as geography and transportation. Through telehealth, isolated seniors in rural communities, without reliable transportation, or unable to leave their homes can have regular visits with their health care professionals to stay on track with treatment plans and medication adherence, helping to promote chronic condition stability, timely intervention for acute conditions, and avoidance of emergencies.
Permanent federal authority for telehealth and hospital-at-home programs is needed to catch up with hospital innovation and patient expectations.
Medicaid DSH Cuts
Federal Medicaid DSH spending is slated to be cut by $8 billion a year over three years. These cuts have been repeatedly delayed since 2014 as lawmakers, on a bipartisan basis, recognize their value in underwriting some of hospitals’ costs of caring for patients without health insurance who cannot otherwise pay for their medical care. The temporary reprieve until Jan. 30, 2026, is welcome, but the moratorium needs to be extended for a longer term to avoid further imperiling hospitals that are already under financial strain.
Federal health care policy and regulation are major factors in whether hospitals are financially stable, whether they can innovate, and whether they can plan for the future with appropriate staffing, equipment, and resources. As Congress gets back to work and tackles another funding package, Florida’s hospitals are relying on them to prioritize common sense health care policy that ameliorates their challenges while supporting their innovations.