Stopgap Policy Extensions Are Undermining Long-Term Care Innovation

With the federal government approaching yet another deadline to renew a suite of critical healthcare policies, the Medical Group Management Association’s (MGMA) January 2026 letter to congressional leadership makes clear what many in the provider space already know: temporary fixes are eroding strategic stability. From telehealth access to clinical lab reimbursement to the core viability of value-based care, the short-term extensions embedded in the latest continuing resolution reflect a dangerous pattern of legislative hesitation at precisely the moment long-term certainty is most needed.

The Consolidated Appropriations Act, 2026 (CAA, 2026) offers a partial reprieve, extending expiring policies through late 2027 in some cases. But it fails to establish permanence in any of the major reform areas that underpin modern care delivery: digital access, rural reimbursement equity, laboratory funding, and the viability of Advanced Alternative Payment Models (APMs). The effect is a system suspended in ambiguity—one in which provider organizations must plan investments, manage risk, and deliver care against a background of perennial policy volatility.

Telehealth’s Future Remains Legislatively Fragile

Among the most urgent policy areas is telehealth. The expiration of key telehealth flexibilities during the recent federal shutdown provided a real-time case study in the operational harm caused by policy gaps. Restrictions on originating site and geographic location were briefly reinstated, reviving barriers that had largely been eliminated during the COVID-19 Public Health Emergency.

While the CAA, 2026 extends these flexibilities through the end of 2027, MGMA warns that continued short-term extensions perpetuate uncertainty for practices and technology vendors that need multi-year clarity to justify infrastructure investment. Legislation such as the CONNECT for Health Act would codify these changes permanently, offering a reliable policy floor upon which care models can evolve.

The stakes are high: Medicare telehealth visits increased more than 60-fold during the first year of the pandemic, and although usage has stabilized, demand remains strong—particularly in behavioral health, chronic disease management, and rural care. A 2025 GAO report found that 88% of providers believe telehealth should remain a core modality for Medicare beneficiaries. Without legislative permanence, those services remain tethered to unstable scaffolding.

Rural Reimbursement Is Still at Risk

The extension of the 1.0 Work Geographic Practice Cost Index (GPCI) floor offers temporary relief to rural providers, but again without long-term guarantees. This payment floor is essential to counterbalance wage and cost disparities that disadvantage rural practices in Medicare’s resource-based payment formulas.

Its expiration during the 2025 shutdown risked immediate reimbursement reductions across vast swaths of underserved communities. Reinstating the floor through 2026 is necessary, but insufficient. A 2024 analysis from MedPAC noted that rural physician retention remains highly sensitive to marginal changes in Medicare payment rates. Unless the GPCI floor is permanently codified, provider flight from rural areas may accelerate, threatening access and increasing downstream health inequities.

Clinical Labs Still Face Unpredictable Funding Environment

The CAA, 2026 delays scheduled 15% cuts to the Medicare Clinical Laboratory Fee Schedule (CLFS) until January 2027, providing brief relief for laboratories that have endured years of reimbursement turbulence under the Protecting Access to Medicare Act (PAMA). While the data reporting window has been updated, concerns remain about the overall methodology used to calculate rates, particularly the continued inclusion of data that may not reflect current costs or volume trends.

The proposed RESULTS Act aims to reform PAMA to better reflect real-world operational costs and ensure sustainable reimbursement for lab testing. Without this reform, the core infrastructure that supports diagnostics, public health surveillance, and preventative screening remains undercapitalized, at precisely the time when laboratory capacity is central to care innovation and population health.

A 2024 Health Affairs study found that even minor reductions in lab reimbursement led to decreased testing access in low-income and rural ZIP codes. The cumulative risk is not just financial; it is clinical.

Value-Based Care Hinges on Policy Continuity

Perhaps the most strategically damaging lapse of the past year was the failure to reauthorize the Advanced APM incentive payment in 2025. That incentive, modest as it may be, has helped defray the upfront technology, staffing, and compliance costs required to transition into risk-bearing care models. Without it, many provider groups paused or canceled their participation in APMs.

The CAA, 2026 proposes reinstating the 3.1% payment and returning to 2024 Qualifying APM Participant (QP) thresholds for performance year 2026. But the signal sent by last year’s lapse, a signal of policy unreliability, may take years to reverse. MGMA’s position is clear: incentives must be locked in through at least 2030 to restore trust and allow practices to invest confidently in value-based care.

The challenge is not abstract. A 2025 CMS Innovation Center review found that 41% of ACOs reduced participation due to financial uncertainty, with many citing the lapse in APM incentives as a primary factor. Restoring this pathway is not only a question of payment; it is a question of sustaining national momentum toward outcomes-based care.

Temporary Policy Is Not a Foundation

The persistent reliance on short-term extensions to manage fundamental Medicare and provider policy is no longer sustainable. These policies are not optional enhancements. Instead, they are core scaffolding for clinical delivery, fiscal planning, and digital modernization. Health systems, vendors, and patient populations are already contending with inflationary pressures, workforce shortages, and technology integration hurdles. Layering legislative instability on top only compounds system-wide vulnerability.

Congress has demonstrated capacity for bipartisan action in healthcare, particularly in crisis contexts. But the current moment demands more than crisis aversion. It requires strategic foresight and legislative resolve to make essential reforms permanent. The tools are available. The pathways are known. What remains in question is the willingness to act.