MINOKA, IL — Bill Swick has a rare degenerative brain disease that hinders his mobility and speech. Instead of spending an hour driving to a clinic in downtown Chicago to see a speech therapist, he benefited from virtual meetings without leaving your home.
But Swick, 53, has not had access to those meetings for the past month.
federal government shutdownnow in its fifth week, has stopped funding the Medicare telehealth program, which pays its provider for its services. So Swick and his wife are practicing old strategies rather than learning new skills to cope with increasing difficulties in processing speech, stringing words together and pacing while speaking.
“It's frustrating because we want to continue his journey, his progress,” said Martha Swick, 45, who has been caring for her husband since his diagnosis three years ago, during an interview at their home in Minooka, Illinois. “I try to organize all the therapy and everything for him to make his day easier and calmer, but then everything goes wrong and we have to stop and wait.”
In recent weeks, their experiences have become commonplace among millions of patients with Medicare fee-for-service plans who are counting on pandemic-era telemedicine waivers to attend medical appointments from home.
With Congress I can't agree under the government funding agreement, waivers expired, even with support from Republicans and Democrats. As a result, healthcare providers are deciding whether they can continue to offer telehealth services without guarantee of reimbursement or whether they need to stop virtual visits altogether.
As a result, patients, who are mostly elderly, have fewer options to see specialists or get help when they are physically unable to travel far from home.
Swick, whose corticobasal degeneration causes symptoms similar to Parkinson's disease, can no longer eat or dress himself and has difficulty maintaining balance and walking. Add to that the logistical nightmare of driving into the city in traffic, and meeting with a speech therapist in person wasn't a worthwhile experience for him and his wife.
But skipping even a few appointments can slow progress for patients with dementia and other degenerative conditions that depend on continuity of care, experts say.
“It feels like you’re taking a step back,” Swick said in an interview.
Before the COVID-19 pandemic, Medicare paid for virtual doctor visits only in special cases, including in certain rural areas and when patients logged in from eligible locations such as hospitals and clinics.
That changed in 2020, when the first Trump administration telemedicine coverage has expanded dramatically in response to a public health emergency. Medicare has begun to reimburse a wide range of telemedicine visits by removing geographic requirements and allowing patients to receive calls from home.
Congress has regularly expanded telehealth flexibilities and was poised to do so again before they expired on September 30. But when budget negotiations stalled and the government shut down on Oct. 1, a vote never took place, leaving the program temporarily without funding.
With more than 4 million Medicare beneficiaries With telehealth use in the first half of 2025, the pause has had a major impact on an already vulnerable population, according to Brown University School of Public Health.
Swick's speech therapy services are provided by Chicago-based Memory and Aphasia Care. Owner Becky Hayum said many of her clients are located in different cities and states and sought out her therapists because they specialize in frontotemporal dementia.
“Now all of a sudden, without telehealth services, they no longer have the support to participate in the activities that are so important to them,” Hayum said. “The risk is that we may see social isolation; we may see an increase in depression and anxiety.”
Virtual visits can also be useful in various areas of medicine. Dr. Faraz Ghoddousi, a family medicine provider in Tigard, Oregon, said he uses telemedicine to check in and help his patients manage their medical conditions, such as diabetes and chronic lung disease. He said that during the current pause in Medicare telehealth, one of his patients missed regular checkups and ended up in the emergency room.
Susan Collins, 73, of Murrieta, California, said Medicare-reimbursed telemedicine appointments were a “huge relief” to her as she provided full-time care for her late husband, Leo. Before he died last year from progressive supranuclear palsy, a rare brain disease, she struggled to lift him in and out of his wheelchair during in-person doctor visits 60 miles from their home.
“He was much safer at home,” Collins said, noting that telemedicine was a helpful resource when her husband needed treatment or advice on symptoms but not a full physical exam.
latest guide from the Centers for Medicare and Medicaid Services does not prohibit health care providers from providing telehealth services during the interruption, but does not promise that they will be reimbursed if they do so.
In response, providers are deciding whether they can take on the risk of continuing treatment without the certainty that they will be paid for it when the government reopens.
Hayum, from Illinois, said she had to stop providing telehealth services to Medicare patients because her small business couldn't handle the instability and potential loss of payments. Ghoddousi, a family medicine provider, said his Oregon practice is accepting telemedicine appointments made before Oct. 1 but is not planning additional appointments for Medicare patients until funding is restored.
Genevieve Richardson, owner of a speech-language pathology business in Austin, Texas, has stopped providing telehealth services to her Medicare clients, who are scattered across the country. She referred them to outpatient clinics in their areas that could provide respite services in person.
Large hospitals are also deciding whether to provide virtual care to Medicare patients. Dr. Helen Hughes, medical director of telehealth at Johns Hopkins Medicine, said the hospital initially continued to provide care but suspended scheduling new Medicare telehealth visits as of Oct. 16 as the closure continued.
She said the uncertainty surrounding the rejections had been a “total rollercoaster.”
The government shutdown is now in its fifth week with no clear end in sight. Meanwhile, Medicare telehealth flexibilities and a separate Medicare program offering patients inpatient home care both remain on pause.
Mei Kwong, executive director of the Center for Unified Health Policy, said the simplest solution to reinstating telehealth waivers would be for Congress to vote on them separately.
Federal health administrators' hands are “kind of tied,” she said. “So you really need Congress to act.”
But with lawmakers divided and seeking leverage, hopes for such action are slim.
Martha Swick, doing word exercises with her husband at their home on a recent morning, said that if a solution isn't found soon, “my collection of resources will run out.”
“I just do what I can at home, being a wife and a caregiver,” she said. “But eventually I will really need these meetings to come back.”
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Swenson reported from New York.
