As Congress enters the final stretch of fiscal year 2025, a wide range of health care programs are set to expire on September 30, 2025, unless Congress takes action. These “health care extenders” cover everything from primary care and rural hospitals to Medicare telehealth services and workforce programs. Many of them have been renewed on a short-term basis for years—often tucked into year-end spending bills. But as the deadline looms, uncertainty grows for providers, patients, and public health programs.
Here’s a breakdown of what’s expiring.
Primary Care and Workforce Programs
Several major programs aimed at improving access to care in underserved areas are set to expire:
Community Health Centers (CHCs): CHCs provide essential primary care to nearly 30 million patients annually. Their core funding—known as the 330 Grant—is set to lapse without an extension of the Community Health Center Fund.
National Health Service Corps (NHSC): The NHSC supports primary care clinicians who work in shortage areas through scholarships and loan repayment. It relies heavily on the same fund that supports CHCs.
Teaching Health Centers Graduate Medical Education: Teaching Health Centers train medical residents in community-based settings. Without renewed funding, many could lose the ability to continue their residency programs.
Public Health Programs
Critical public health initiatives are also facing the end of federal funding:
Special Diabetes Programs: The Type 1 Diabetes program funds NIH research and the program for Indians supports tribal and Indian Health Service services.
Personal Responsibility Education Program: This program funds evidence-based initiatives to reduce teen pregnancy and promote adolescent health.
Medicare Extenders
Several Medicare provisions with significant implications for rural providers and seniors will expire:
Medicare-Dependent Hospital (MDH) Program: Provides additional funding to rural hospitals where a high percentage of patients are on Medicare
Low-Volume Hospital Payment Adjustment: Supports rural hospitals with limited inpatient volume to help them remain financially viable
Work Geographic Practice Cost Index (GPCI) Floor: Ensures that Medicare payments to rural physicians aren’t reduced unfairly based on geographic payment formulas
Telehealth Flexibilities: These pandemic-era provisions include waivers for geographic restrictions, audio-only telehealth, and expanded provider eligibility
Hospital at Home Waiver: CMS authority to allow acute-level care to be delivered at home under Medicare
Ground Ambulance Add-On Payments: Payment increases for rural and super-rural ambulance services
Medicare Quality Measurement Support: CMS funding for developing and endorsing Medicare quality metrics
Medicare Outreach and Enrollment Support: Assistance programs that help low-income seniors navigate Medicare
Medicaid and Behavioral Health
Medicaid Disproportionate Share Hospital (DSH) Payment Cuts: Delayed cuts to safety-net hospitals are scheduled to take effect. Without another delay, hospitals serving large numbers of low-income or uninsured patients would lose significant funding.
Certified Community Behavioral Health Clinics (CCBHCs): The original demonstration authority for CCBHCs in 2016 states will expire. While the program is now an optional Medicaid benefit, not all states have opted in.
Other Key Programs
Conrad 30 Waiver Program: Allows international medical graduates on J-1 visas to stay in the U.S. in exchange for practicing in underserved areas
Children’s Hospital Graduate Medical Education (CHGME): Supports pediatric residency programs
What Happens Next?
With dozens of health care programs scheduled to expire on September 30, 2025, Congress faces a significant number of time-sensitive decisions. Here are their options:
- Make some or all of these programs permanent
- Extend some or all of these programs for a year or more
- Align the extension of some or all of these programs with a continuing resolution to fund the entire federal government past September 30, 2025
If past is prologue, Congress will delay making permanent decisions on these programs and opt for some sort of extension. While health care providers need certainty to continue or revise programs, unfortunately Congress – regardless of which party is in control – has disappointed the health care sector before. But if faced with no extension or elimination of funding and authority, health care providers will be forced to support short-term patches.