The Latest from Washington, DC

ACA Subsidies

In the fall of 2025, the federal government experienced a 43-day shutdown over the impending expiration of the Affordable Care Act (ACA) Enhanced Premium Tax Credits (EPTCs). Ultimately, Congress was unable to reach an agreement, and the subsidies expired at the end of 2025. As a result, millions of Americans are experiencing significant premium increases in 2026. 
However, Congress has continued efforts to re-implement them in 2026. In the first week of January, House Democrats successfully used a discharge petition to force a vote on a three-year extension of EPTCs against the wishes of House leadership. The bill passed the House with support from 17 Republicans; however, it is unlikely to proceed in the Senate. Alternatively, a bipartisan group of Senators continues to meet in hopes of reaching a compromise. This could be an extension of the subsidies with certain reforms.   
In early 2026, President Trump announced an alternative solution to the ACA EPTCs, “The Great Healthcare Plan.” This new health insurance initiative is aimed at reducing drug prices and insurance premiums, holding insurance companies accountable, and maximizing price transparency. Operationally, the plan would redirect money from health plans and drug companies to patients directly, who are then in charge of buying their own healthcare. This plan would require an act of Congress to become law.

Government Funding Deadline Approaches

Although Congress passed a Continuing Resolution (CR) to end the 43-day government shutdown, the measure only extended government funding through January 30, 2026. To avert another shutdown, Congress has since advanced the FY 2026 appropriations process (the fiscal year began October 1), passing six of the twelve required appropriations bills to date: Agriculture; Military Construction and Veterans Affairs; Legislative Branch; Commerce, Justice, and Science; Energy and Water; and Interior and Environment. 
As of mid-January, there are six more funding bills necessary to fund the government, including the Labor- Health & Human Services bill which funds many rural health programs. If Congress fails to pass all six, the government will partake in a partial government shutdown just for those applicable agencies. Congress may also choose to pass a partial Continuing Resolution (CR) to punt funding for those six agencies only. 

Telehealth

CMS has used their authority to extend RHC Medicare medical telehealth flexibilities through December 31, 2026. In this time, patients can continue to receive services from their homes or other locations, and RHCs should bill G2025. 
Medicare telehealth flexibilities for fee-for-service providers however will expire January 30th. In this expected extension, we continue to advocate for a fix to RHC telehealth policy, which would allow you to bill telehealth visits as eligible encounters. 
Please click here to contact your Members of Congress and urge them to include a fix for RHC telehealth reimbursement and billing in the next extension.

Rural Health Transformation Program

In 2025, the Centers for Medicare and Medicaid Services (CMS) unveiled the Rural Health Transformation Program (RHTP), a $50 billion initiative to strengthen healthcare in rural America by funding state-led strategies. 
In case you missed it, the Centers for Medicare and Medicaid Services (CMS) announced awards for the Rural Health Transformation Program (RHTP). Per the statute, CMS awarded all 50 states with an approved application an equal share of half of the funding ($25 billion). The remaining funds will be allocated to states in amounts ranging from $147 million to $281 million, based on application materials and other criteria outlined in the Notice of Funding Opportunity (NOFO). The state award list for FY26 can be found here. NARHC continues to engage with stakeholders to ensure RHCs are part of state RHTP plans.

Judge Blocks 340B Rebate Model

Recently, a judge paused the implementation of the 340B rebate model pilot program set to take effect on January 1, 2026. This program would require covered entities to pay full prices for drugs upfront and be reimbursed afterwards. Many folks in the industry expressed concern over the rapid pace of implementation, associated administrative burdens, and high upfront costs. While the ruling delays the rebate model from starting in January, the case is still ongoing, so it could end up being implemented later this year.