The 43-day shutdown of the U.S. government in October and November 2025 complicated lots of things for lots of people, and that included the operation of ambulance organizations that rely on federal reimbursement of their services to Medicare patients.

The day before the shutdown began, the temporary ground ambulance add-on payments provided by the Centers for Medicare & Medicaid Services (CMS) lapsed. Many EMS organizations rely on those payments – an extra 2% for urban services, 3% for rural and 22.6% for super-rural – to help offset regular reimbursements that don’t meet the costs of providing service. With government not functioning, those payments were not immediately restored.

Medicare reimbursements didn’t stop, but CMS had its contractors place holds on claims submitted while it continued. This was intended to provide some breathing room if the shutdown was short. It wasn’t, and contractors ultimately had to pay claims from October 1 and later at the statutorily required base amounts — which didn’t include the add-ons. That was a small but significant blow at the margins for many services that operate without a lot of breathing room.

The shutdown also created uncertainty and administrative disruption across federal health programs and with the “extenders” — for instance, telehealth and home hospital care waivers — relied upon by many EMS and hospital providers. Medicaid funding generally continued, but providers and states faced uncertainty and delays in some functions.

The experience underscored the fragility of many EMS organizations’ cash flow and how easily it can be disrupted.