As Congressional Democrats and Republicans continue to trade blows in a standoff over government funding, the resulting government shutdown that began at 12:01 a.m. on Oct. 1 has already started impacting average Americans.

While some public benefits like Social Security payments and general Medicare and Medicaid coverage continue to be paid during a shutdown, seniors who rely on Medicare could still face major changes and new barriers to receiving medical care.

Two COVID-era programs that expanded access to healthcare expired on Sept. 30, despite having largely bipartisan support: One provided greater flexibility around telehealth and another allowed hospitals to continue high-level care at home. Both lost funding when lawmakers failed to pass a budget plan addressing either, resulting in some near-immediate changes for Medicare recipients.

Here's what to know about telehealth and in-home care services during the shutdown.

Are telehealth services impacted by the shutdown?

As part of the shutdown, Congress missed the deadline on extending COVID-era telehealth programs for Medicare beneficiaries, meaning previous restrictions will go back into place until lawmakers pass some sort of budget measure, according to the Centers for Medicare & Medicaid Services (CMS).

Budgets proposed from both sides would have continued the flexibilities through at least October or November, but the current spending stalemate has left coverage up in the air. Before the COVID-19 pandemic, there were tighter restrictions on who could get telehealth services covered by Medicare; for the most part, virtual healthcare appointments were reserved for beneficiaries living in rural areas or care facilities, or those working with certain types of providers.

While some of these changes were permanent, others continued to rely on temporary waivers to operate. Some of these temporary allowances included the ability to use telehealth services from anywhere without geographic restrictions, have appointments in audio-only formats and receive mental health and behavioral healthcare virtually without regular in-person appointments.

During the shutdown, these services, which expired on Sept. 30, will no longer be available to Medicare recipients. Patients can no longer receive telehealth from home unless they meet specific criteria; telehealth flexibility will again be limited to rural areas; audio-only visits will no longer be reimbursed for most services; and physical therapists, occupational therapists, speech-language pathologists and audiologists will be excluded from telehealth reimbursement.

As a result, providers are now uncertain whether telehealth services delivered during the lapse will be reimbursed retroactively and some are refraining from submitting telehealth claims until Congress passes a budget, according to the American Telemedicine Association (ATA).

Advocates and organizations like the ATA and the Center for Connected Health Policy have said this could impact some of the most vulnerable populations in the U.S., including millions of seniors who rely on telehealth for chronic care, mental health and post-operative check-ins, those with disabilities, or people living in underserved areas who face physical limitations to accessing in-person care.

Is in-home healthcare impacted by the shutdown?

The CMS Acute Hospital Care at Home initiative (AHCAH) also expired on Sept. 30, meaning patients who receive high-level care at home for acute conditions face being discharged or forced back into the hospital for an unspecified amount of time.

This COVID-era program also relies on waivers, which allow hospitals to provide inpatient-level care to Medicare recipients at home. This will affect over 400 hospitals across 39 states that participate in AHCAH, according to CMS.

"For all hospitals with active AHCAH waivers, all inpatients must be discharged or returned to the hospital on September 30, 2025, in the absence of Congressional action to extend the initiative," a notice atop the page about the program read on Oct. 1. "CMS will no longer accept waiver requests for participation in the AHCAH initiative after September 1, 2025."

Until a new budget resolution that addresses this program is passed, Medicare patients who rely on AHCAH care can expect readmission to the hospital or the end of their at-home services, at least temporarily.

This article originally appeared on USA TODAY: Millions of seniors could lose access to telehealth and in-home care during shutdown

Reporting by Mary Walrath-Holdridge, USA TODAY / USA TODAY

USA TODAY Network via Reuters Connect