MINOOKA, Ill. — Bill Swick has a rare degenerative brain disease that inhibits his mobility and speech. Instead of the hassle of traveling an hour to a clinic in downtown Chicago to visit a speech therapist, he has benefited from virtual appointments from the comfort of his home.
But Swick, 53, hasn’t had access to those appointments for the last month. The federal government shutdown, now in its fifth week, halted funding for the Medicare telehealth program that pays his provider for her services.
So, Swick and his wife are practicing old strategies rather than learning new skills to manage his growing difficulties with processing language, connecting words, and pacing himself while speaking.
“It’s frustrating because we want to continue with his journey, with his progress,” said Martha Swick, 45, who has been her husband’s caregiver since his diagnosis three years ago. She spoke during an interview at their home in Minooka, Illinois. “I try to have all his therapy and everything organized for him, to make his day easier and smoother, and then everything has a hitch, and we have to stop and wait.”
Their experience has become common in recent weeks among millions of patients with Medicare fee-for-service plans who rely on pandemic-era telehealth waivers to attend medical appointments from home. With Congress unable to agree on a deal to fund the government, the waivers have lapsed — even with bipartisan support.
As a result, medical providers are now deciding whether they can continue offering telehealth services without guaranteed reimbursement or whether they need to halt virtual visits altogether. This has left a patient population, mostly older adults, with fewer options to seek specialists or get help when they cannot physically travel far from home.
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### Challenges of In-Person Therapy
Swick’s corticobasal degeneration causes symptoms similar to Parkinson’s disease. He can’t feed or dress himself anymore and struggles with balance and walking. Add the logistical nightmare of driving to Chicago through traffic, and in-person speech therapy appointments are not a worthwhile ordeal for him and his wife.
But missing even a few appointments can impede progress for patients with dementia and other degenerative conditions who depend on continuity of care, experts say.
“It feels like you’re taking a step back,” Swick said.
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### A Temporary Pause with Significant Impact
Before the COVID-19 pandemic, Medicare only paid for virtual medical appointments under narrow circumstances — including in designated rural areas and when patients logged in from eligible sites like hospitals or clinics.
That changed dramatically in 2020 when the Trump administration expanded telehealth coverage in response to the public health emergency. Medicare began reimbursing a wide range of telehealth visits, removing geographic restrictions and allowing patients to take calls from their homes.
Congress routinely extended these telehealth flexibilities and was poised to do so again before their expiration on September 30. But when budget negotiations stalled and the government shut down on October 1, the vote never happened, leaving the program temporarily unfunded.
With more than 4 million Medicare fee-for-service beneficiaries using telehealth in the first half of 2025, according to Brown University’s School of Public Health, the pause has had a major impact on an already vulnerable population.
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### Impact on Telehealth Providers and Patients
Swick’s speech therapy services are provided by Memory and Aphasia Care, a Chicago-area business specializing in frontal temporal dementias. Owner Becky Khayum said many of her clients reside in different cities and states and sought her therapists out specifically for their expertise.
“Now suddenly without telehealth services, they do not continue to have the support to participate in those activities that are so important to them,” Khayum said. “The risk is we could see social withdrawal; we could see depression and anxiety increased.”
Virtual visits are also valuable in other areas of medicine. Dr. Faraz Ghoddusi, a family medicine provider in Tigard, Oregon, uses telehealth to check in and help his patients manage chronic conditions like diabetes and lung disease. He noted that during the Medicare telehealth pause, one of his patients missed regular check-ins and ended up in the emergency room.
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### Telehealth’s Role for Caregivers
Susan Collins, 73, from Murrieta, California, said Medicare-reimbursed telehealth appointments were a “tremendous relief” when she was a full-time caregiver for her late husband, Leo. Before he died last year from progressive supranuclear palsy, a rare brain disorder, she struggled to lift him in and out of their car for his in-person doctor visits — which were 60 miles from their home.
“He was much safer at home,” Collins said, adding that telehealth was useful when her husband needed medication or symptom consultations but not a complete physical exam.
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### Providers React Differently Amid Funding Lapse
The Centers for Medicare and Medicaid Services (CMS) have not banned medical providers from offering telehealth services during the lapse but stop short of promising reimbursement.
In response, providers are making tough decisions about whether they can absorb the risk of continuing care without payment assurances.
Khayum said her small business had to stop providing telehealth to Medicare patients because they couldn’t handle the financial volatility.
Dr. Ghoddusi shared that his practice is honoring telehealth appointments made before October 1 but is not scheduling new ones for Medicare patients until funding is restored.
Genevieve Richardson, owner of a speech pathology business in Austin, Texas, has stopped offering telehealth to her Medicare clients across the country and is referring them to outpatient clinics nearby for in-person care.
Major hospitals face similar challenges. Dr. Helen Hughes, medical director of the Office of Telemedicine at Johns Hopkins Medicine, said the hospital initially continued telehealth care but paused scheduling additional Medicare telehealth visits as of October 16 due to the ongoing shutdown. She called the uncertainty surrounding the waivers “a total roller coaster.”
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### Congressional Stalemate Continues
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 hospital-level care at home remain paused.
Mei Kwong, executive director of the Center for Connected Health Policy, said the simplest solution for renewing telehealth waivers would be for Congress to vote on them separately.
“The hands of federal health care administrators are kind of tied,” Kwong explained. “So, you really do need Congress to act.”
But with lawmakers divided and using funding negotiations as leverage, hopes for swift action are low.
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### Caregivers Struggle as Resources Run Out
At home, Martha Swick continues practicing word exercises with her husband. But she worries that if a solution isn’t found soon, “my resource collection is going to run out.”
“I’m just doing what I’m able to at home as a wife and a caregiver,” she said. “But eventually I’m really going to need those appointments to come back.”
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*Reporting by Swenson from New York.*
https://www.clickorlando.com/health/2025/10/30/patients-go-without-needed-treatment-after-government-shutdown-disrupts-a-telehealth-program/