What HHS Layoffs Mean for Patients and Access to Rehabilitation Care

By Susan Lofton, VP of outcomes & clinical transformation, WebPT.

The recent layoffs at the Department of Health and Human Services (HHS) have far-reaching implications, not just for policymakers and providers, but for patients who rely on rehabilitation therapy services.

With HHS reducing its workforce by 25%, critical functions that support patient access, program funding, and policy guidance are under pressure.

With 300 positions eliminated at the Centers for Medicare & Medicaid Services (CMS), the agency faces a reduced capacity to provide operational support. This affects implementation guidance, billing and coverage clarification, and problem resolution. When new rules take effect, fewer staff are available to respond to therapists’ questions, creating delays that directly impact patient access and timely care delivery.

Impact on Patient Access and Services

The workforce changes have several potential implications for patients who receive rehabilitation services:

Telehealth Access Beyond September 2025

Medicare telehealth waivers that allow rehabilitation therapists to provide services remotely expired on September 30, 2025. Without further legislative action, PTs, OTs, and SLPs are not able to receive Medicare reimbursement for telehealth services billed after that date.

This matters particularly for homebound patients and those in rural areas who rely on remote therapy services. The uncertainty about telehealth creates significant planning challenges for practices that have incorporated telehealth into their service models and for patients who depend on remote access to care.

Service Delivery and Patient Access

When policy guidance is delayed or unclear, and when administrative processes take longer due to reduced staffing, healthcare facilities face challenges in service delivery. This can translate into longer wait times for appointments, delays in starting treatment, and uncertainty for practices trying to navigate new policies with less federal support available to answer questions.

Research and Future Innovation

Changes to National Institutes of Health (NIH) research funding and oversight may affect the timeline for translating new research findings into clinical practice. While research will continue, the reduced capacity for managing research programs could slow the development and dissemination of new rehabilitation techniques and evidence-based practices that ultimately benefit patients.

Impact on Specific Populations

Jill Jacobs, executive director of the National Association of Councils on Developmental Disabilities, commented on the changes to the Administration for Community Living: “People with disabilities are at risk. This isn’t just about shifting funding. They are taking away a federal agency that is for and about people with disabilities and those who are aging.” 

Patients from lower-income backgrounds, those with rare conditions, or individuals in rural areas often rely more heavily on federally supported programs. The Administration for Community Living specifically served older adults and people with disabilities – populations that frequently require PT, OT, and SLP services.

Quality Oversight

A smaller HHS workforce means reduced capacity for oversight activities. This includes monitoring of Medicare Advantage plans, which have become the primary Medicare option for many beneficiaries. According to a senior CMS official quoted in Government Executive: “Service standards for Medicare Advantage beneficiaries and Affordable Care Act consumers will suffer with a reduction in the people that handle their cases and with diminished oversight of the Medicare Advantage plans.”

What Rehabilitation Therapists Should Do

Given these changes, there are several practical steps therapists can take:

1. Stay Informed: Monitor updates through professional organizations – the American Physical Therapy Association (APTA), American Occupational Therapy Association (AOTA), and American Speech-Language-Hearing Association (ASHA). These organizations track policy developments and provide guidance to their members.
2. Plan Financially: With the 2026 final rule expected in November, practices should prepare for potential scenarios. Reduced CMS staffing may affect both the timing of the final rule and the availability of implementation guidance. Plan conservatively until the final rule provides clarity on actual reimbursement rates. Consider payer mix strategies that reduce dependence on any single payment source.
3. Document Thoroughly: Maintain thorough documentation. With reduced federal staffing and potential delays in policy clarification, clear records become increasingly important for managing audits and payment disputes.
4. Advocate: Contact congressional representatives to share how policy changes or delays affect your practice and patients. With the September 30 telehealth deadline lapsing, this is particularly urgent. Specific examples and concrete data are most effective. Participating in future public comment periods on proposed rules provides an opportunity to share your clinical perspective and concerns about policy changes.
5. Continue Professional Development: Stay current with continuing education and evidence-based practices, even as research funding patterns may shift.

Looking Ahead to 2026 and Beyond

There is debate about whether these workforce reductions will achieve the HSS stated efficiency goals or whether they will compromise service delivery. Public health experts have noted that maintaining current service levels with a significantly reduced workforce will be challenging; however, some proponents suggest the changes could lead to greater emphasis on chronic disease prevention, an area where rehabilitation therapists play an important role through mobility training, functional rehabilitation, and prevention of secondary complications. Whether reduced federal staffing will support or hinder initiatives in this area remains to be determined.

The Bottom Line

The HHS workforce reductions represent a significant change in federal healthcare administration. For rehabilitation therapists, this means navigating uncertainty around payment policies, adapting to potential delays in policy implementation and guidance, and managing possible changes in program funding. For patients, particularly those who depend on federally funded programs or Medicare services, there may be impacts on access timing and service availability.