From DC: Federal Government Shutdown, Threats to Permanent Supportive Housing Programs, and more

Federal Government Shutdown Continues

The federal government remains shut down after Congress was unable to negotiate an extension of federal funding, which expired at the end of September. Key issues include the extension of Affordable Care Act (ACA) enhanced premium tax credits (EPTCs) that are set to expire at the end of the year and reversing Medicaid cuts included in H.R. 1, the reconciliation bill passed in July. If EPTCs expire, individuals enrolled in the Marketplace could see premium increases of over 500%, and older adults ages 50-64 will be disproportionately affected.

As a result of the shutdown, non-essential government services are paused. The impacts vary across agencies as outlined in their contingency plans. Importantly, public programs that are mandatorily funded, including Social Security, Supplemental Security Income (SSI), Medicare, and Medicaid are expected to continue. Additionally, most tenants receiving federal rental assistance should continue to receive their rental subsidies through November.

However, older adults may experience disruptions in how they receive services from these programs, especially if the shutdown persists. For example, the Social Security Administration is pausing certain services, such as processing overpayments and issuing replacement Medicare cards. Some health care policies also expired, including telehealth visits for the majority of Medicare enrollees and the Acute Hospital Care at Home Initiative.

Justice in Aging will continue to update our network about the shutdown’s potential impacts on older adults.

Threats to Permanent Supportive Housing for People Experiencing Homelessness

Recent reporting from Politico revealed the Department of Housing and Urban Development (HUD)’s plan to defund permanent supportive housing (PSH) programs. PSH provides long-term rental assistance with supportive services for people experiencing chronic homelessness. Older adults age 55 and over comprise 40% of PSH residents, who include people with disabilities and complex health conditions.

Currently, HUD’s Continuum of Care (CoC) homeless assistance program prioritizes funding PSH, with 87% of funds supporting PSH programs. However, HUD intends to cap funding for PSH to 30% of CoC funds to shift more funding to temporary forms of assistance, such as transitional housing. These drastic cuts would put approximately 170,000 people in PSH at risk of losing their housing and services.

Learn more about PSH and HUD homeless assistance in this Justice in Aging primer. Advocates should also urge Congress to include a provision in upcoming spending bills that protect PSH funding for next year.

New Report on Potential Harmful Changes to SSDI and SSI

The Social Security Administration will likely release a proposed rule this fall that could change how age and education are considered in determining disability in the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs.

A new Urban Institute report analyzes the harmful effects of these potential regulatory changes to SSDI and SSI, particularly for older adults. According to the report, changes to the treatment of age and education could reduce eligibility for new applicants to the SSDI program by 20% overall and up to 30% for people over age 50.

Just a 10% reduction in eligibility would result in roughly 500,000 people losing benefits, including 80,000 widows and children. Older adults who are denied and resort to early retirement for income would see a lifetime benefit that is 30% lower than what they would have received had they qualified for SSDI.

Justice in Aging will continue to monitor this issue and update our network about the future proposed rule.

New Demonstration to Waive Medicare’s 3-Day Hospital Stay Rule for Skilled Nursing Facility Coverage

To be eligible for Medicare covered skilled nursing facility services (SNF), Medicare enrollees must have a 3-day qualifying stay as an in-patient in a hospital, which can be a barrier to access medically necessary SNF services.

The Centers for Medicare and Medicaid Services (CMS) is launching a new Transforming Episode Accountability Model (TEAM) to allow waiver of the 3-day stay starting January 1, 2026 through December 31, 2030. TEAM will allow participating acute care hospitals to discharge eligible patients without the 3-day hospital stay to a qualified SNF.

Per CMS guidance, to be eligible, patients must be enrolled in Original Medicare Parts A and B and have an in-patient hospital stay or outpatient hospital procedure for one of five surgeries (lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure).

Justice in Aging supports efforts to eliminate these barriers to the Medicare SNF benefit, including the Improving Access to Medicare Coverage Act of 2025 (H.R. 3954), which would count observation status days toward the 3-day stay requirement.

We also co-counseled a successful class action lawsuit led by the Center for Medicare Advocacy to secure appeal rights for certain Medicare enrollees who are barred from SNF services because the hospital changes their status from “inpatient” to “outpatient.” See our flowcharts for more about the expedited appeals process that took effect February 14, 2025, and the time-limited retrospective appeals process for individuals who experienced a change in status on or after January 2009.

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