Robert Thornton received personalized hospital care for COVID-19 and pneumonia in his Belvidere, Ill., home in 2024 as part of a Medicare in-home care program that expired October 1. (Photo courtesy of OSF Healthcare)

The federal government shutdown is forcing a reckoning for two remote health care programs because they automatically expired Oct. 1.

The telehealth and in-home hospital care programs were both temporary — but increasingly popular — options for Medicare recipients. They allowed doctors and hospitals to bill Medicare for telehealth appointments and in-home visits from nurses to provide care that is generally only available in hospitals.

The shutdown has prevented Congress from extending them.

More than 4 million Medicare beneficiaries used telehealth services in the first half of the year, according to Brown University’s Center for Advancing Health Policy through Research.

As of last fall, 366 hospitals had participated in the hospital-at-home program, serving 31,000 patients, according to a federal report. The program, officially called Acute Hospital Care at Home, allows patients who would otherwise be hospitalized to get inpatient care at home with a combination of nurse visits, monitoring equipment and remote doctor visits.

The programs have their roots in the pandemic, when doctors and hospitals wanted to keep patients safe from the risks of travel and hospital stays. Both are for Medicare recipients, generally people over 65 or who are disabled. But since many private insurers follow federal guidelines, some physicians have stopped booking telemedicine appointments for non-Medicare patients, rather than risk a change in insurance coverage.

Alexis Wynn, who is in her mid-30s and covered by private insurance through her employer, tried to switch an in-person doctor appointment in Pennsylvania to a video visit last week. The office told her that “all telemedicine is uncovered by insurance as of Oct. 1” — so she had to cancel the routine appointment.

“It was just a follow-up appointment  to make sure the dosing of my medication was still accurate, nothing that was pertinent to being face-to-face,” Wynn said. Her health insurance company later told her it still covered telehealth visits.

There have been other reports of insurers turning down non-Medicare telehealth appointments, said Alexis Apple, director of federal affairs for the American Telemedicine Association, a trade group.

“It’s a misunderstanding,” Apple said. “I’m not really sure what’s happening, but it’s unfortunate and very scary. There’s so much uncertainty out there now, and we see insurance payers start to pull back.”

Both telehealth and home hospital services can be a lifeline for older people, especially in rural areas, where residents may struggle to travel long distances for health care in person.

“In rural America, it’s often telemedicine or no medicine at all,” said Dr. David Newman, chief medical officer of virtual care at Sanford Health in South Dakota, in a September statement supporting congressional action to make Medicare telehealth permanent. Bipartisan bills that would have allowed telehealth to continue stalled in committee earlier this year in the Senate and House.

There’s an exception for telehealth rural residents — but only if they travel to a brick-and-mortar health care facility to get the remote health care service.

“The patients have to go to a clinic to receive that telehealth visit from a provider in a different location,” Apple said. “It kind of defeats the purpose.”

According to the Brown University report, California had the highest rate of Medicare telehealth usage in the first six months of this year, with 26% of beneficiaries using at least one telehealth appointment, followed by 23% in Massachusetts and 21% in Hawaii.

There’s no reason for non-Medicare insurers to stop covering any telehealth visits during the shutdown, and even most Medicare Advantage programs will continue to cover telehealth, according to Tina Stow, a spokesperson for AHIP, a health industry trade association.

Nevertheless, at least some health care centers are refusing to take new telehealth appointments or are converting existing ones to office visits.

“This is causing a lot of confusion. We are still working with our members who are insurers and providers to get a gauge on what folks are doing — because at this point reports we’ve seen seem to suggest it is company by company, provider by provider,” said Sean Brown, a spokesperson for the Health Leadership Council, representing CEOs of health care firms and insurers.

The hospital-at-home program serves a smaller number of patients but its pause has caused more disruption: The federal government required patients to be discharged from the program or transferred to a brick-and-mortar hospital by Oct.1.

The Minnesota-based Mayo Clinic had 30 patients in the program in Arizona, Florida and Wisconsin — all of whom either had to be released from the program or sent to brick-and-mortar hospitals. One of Mayo’s hospitals in Florida was already over capacity and had no room for transfers, according to reporting by Becker’s Hospital Review.

In Massachusetts, which requires commercial insurers to follow Medicare guidelines, all insured patients had to leave the program. Mass General Brigham, which operates many hospitals in the state, has rejiggered its plans to create more home care without relying on the hospital-at-home program, according to the Becker’s report.

Congress was unable to avert a shutdown by late September, and some individual providers and patients were caught unawares.

Nurses on social media discussed losing home-care jobs or being reassigned overnight when the hospital-at-home program closed Oct. 1. They worried about patients being taken away from children at home, or placed in hallway beds at overcrowded emergency rooms because of the abrupt change.

“Management scheduled a random call this morning with a super vague title. Then drop the bomb on us,” wrote one poster in Texas. “So no job. Perfect!”

In a direct message, the poster, who didn’t want their name used for fear of getting in trouble at their hospital, told Stateline, “This obviously wasn’t ideal for the patients. One of them had four children and now could no longer be home with them. Some didn’t even get to have a bed in the hospital because there were none available and had to stay in the ER in a hallway bed.”

Parkland Health System in Dallas started tapering off its hospital-at-home program in September because of the impending shutdown, and the last patients were discharged from the program by Sept. 30 without returning to the hospital, spokesperson Wendi Hawthorne said.

“We are hopeful that Congress will renew this innovative model of care in the future,” Hawthorne said.

Likewise, OSF Healthcare in Peoria, Illinois, had started to wind down its hospital-at-home program “to avoid needing to return multiple patients to a very crowded facility,” said Jennifer Junis, president of OSF OnCall, which handles home hospital care.

There were only three patients in the program Sept. 30, all of whom were ready to be discharged without returning to the hospital, Junis said. Since the program’s start in 2020, it has helped 980 patients with home care through OSF’s Saint Francis Medical Center in Peoria.

“It is unfortunate that we will not be able to benefit by treating qualifying patients at home, where they are most comfortable and recover faster,” Junis said. “Our digital hospital program has allowed us to free up beds for our sickest patients who need them most.”

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.

Oil pumpjacks are seen in a field near a wind turbine in April in Close City, Texas. Weak oil prices have led to recent energy layoffs in Texas and North Dakota. (Photo by Brandon Bell/Getty Images)

Friday’s jobs report is missing in action because of the federal shutdown, but economists are finding other ways of measuring apparent job losses concentrated in Midwestern states and oil country.

Unemployment could continue to rise, especially for Black people, who have borne the brunt of recent job losses.

Friday’s jobs report for September was missing because of the federal government shutdown. The U.S. Bureau of Labor Statistics staff responsible for collecting, analyzing and releasing the data have been furloughed since Wednesday.

The jobs report is useful to economists, government agencies such as the Federal Reserve, and investors trying to gauge the state of the economy, said Elise Gould, senior economist for the left-leaning Economic Policy Institute. If the data is missing for an extended time, it could distort such forecasts, she said.

“We still have some information on the economy from other sources, yes. None of the other indicators predict perfectly. There’s no replacement for the data,” Gould said.

Still, other groups are using their own measuring tools and sharing that information. ADP, a private payroll processing company, showed a decline of 32,000 jobs for the month of September.

The result “further validates what we’ve been seeing in the labor market, that U.S employers have been cautious with hiring,” ADP’s chief economist, Nela Richardson, said in a statement.

Austan Goolsbee, president and CEO of the Federal Reserve Bank of Chicago, said in an appearance on CNBC Friday morning that the available data shows weakness in both the labor market and in attempts to control inflation, making the Fed’s job difficult in deciding whether to stimulate the economy or rein it in.

“You’re seeing deterioration on both sides of the mission,” Goolsbee said. “The BLS data is the best in the world, and it does create difficulties when you’re kind of putting up a screen and you can’t see the data.”

Indiana, while gaining some new jobs in the Kokomo area for car parts and batteries factories, saw September layoffs of more than 1,600 workers, according to state figures. That includes 248 hospitality workers at a convention center in Evansville, 200 warehouse workers at a Target distribution center in Indianapolis, 123 layoffs at a security guard firm that lost a federal contract, and layoffs at two automotive parts factories totaling 189 workers.

Ohio also saw layoffs of 768 workers starting in September at a Kohl’s e-fulfillment in Middletown.

Black unemployment, which has spiked from 4.8% in April 2023 to 7.5% in August, has likely increased again, said Joseph Dean, who monitors it for the National Community Reinvestment Coalition, which encourages more investment in underserved communities.

“If there were a jobs report, I’d expect a rise in the Black unemployment rate,” Dean said. “It’s likely due to a combination of factors: federal layoffs earlier in the year, anti-DEI efforts, and now primarily, stagnation in industries that employ large numbers of Black workers — like transportation and professional/business services.”

Another indicator of labor market trouble, initial claims for unemployment, were up 85% in North Dakota and 44% in Texas from August to September, according to numbers through the week ending Sept. 20 from the U.S. Department of Labor. Weak oil prices have led to recent energy layoffs in those states.

In another private survey that could help gauge the health of the labor market, outsourcing firm Challenger, Gray and Christmas reported Thursday that companies have reported more than 54,000 job cuts in September. That’s a slower rate than August but brings the total this year to 946,000 job cuts, the highest since the pandemic in 2020 and up 55% from the first three quarters of 2024.

The leading reason for job cuts has been actions by the Trump administration’s Department of Government Efficiency task force, the firm said, including cuts to government jobs and “downstream impacts” of the federal cuts, such as loss of funding to nonprofits.

There were also about 7,000 technology jobs lost to AI disruption in September, making it harder to land entry-level jobs, the firm said.

“Right now, we’re dealing with a stagnating labor market, cost increases, and a transformative new technology,” said Andy Challenger, a labor expert at the firm, in a statement.

In August, some of the largest increases in the unemployment rate over the previous year were in Texas cities on the border with Mexico: 2 percentage points each in Brownsville-Harlingen (to 7.5% from 5.5% in 2024) and Eagle Pass (to 8.9% from 6.9% last year). Those metro area estimates for August were released Oct. 1.

Cedar Rapids, Iowa, saw a 1.8-point increase in unemployment from 3.6% to 5.4%, and there were 1.7-point increases in Blacksburg, Virginia (from 4% to 5.7%), and Grants Pass, Oregon (from 6.1% to 7.8%).

Unemployment fell the most in Kokomo, Indiana, (down nearly 4.5 points from 10.7% to 6.2%) where Stellantis has been adding jobs in its automotive parts and batteries plants.

An earlier Stateline analysis showed New Jersey and Virginia were among the states most impacted by job losses in the second quarter of the year as federal cuts and corporate restructuring took a toll.

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org

The injunction covers 50 areas in 14 states, including Pennsylvania.

A Stateline analysis of the data shows how several states, especially Virginia and New Jersey, shed jobs in the second quarter of this year, which includes May and June.

The injunction covers 50 areas in 14 states, including Pennsylvania.

A Stateline analysis of the data shows how several states, especially Virginia and New Jersey, shed jobs in the second quarter of this year, which includes May and June.

Funding for housing, transit, health care, civil rights and other essential programs has been threatened by new grant conditions, according to the lawsuit, which now includes 60 cities, counties and other entities.