Over the next several days, Congress will need to enact 12 appropriation bills, essentially establishing the limits governing the federal government’s ability to spend money.
The authority to operate several federal programs expires on September 30, 2025 (see the table below).
Discretionary programs include but are not limited to 1) many of the federal agencies; 2) tax expenditures, or tax credits, such as the electric vehicle tax credit and the enhanced subsidies for purchasing health coverage (expires on December 31, 2025), known as advanced premium tax credits; and 3) spending programs like the National Flood Insurance Program or Temporary Assistance for Needy Families.
Absent federal spending authority, expiring discretionary programs will temporarily cease, and portions of the federal government could shut down, impacting New Yorkers’ access to services and supports. This would also include New Yorkers’ access to federal parks, monuments, and offices. Contingency plans operationalizing the number of staff furloughed or eliminated, and agency processes would be coordinated by the Office of Management and Budget for each impacted agency, giving the Trump administration discretion during the shutdown. Recent prior shutdowns have not included large-scale reductions in the federal government’s workforce; however, recently issued guidance suggests the Trump administration may pursue a reduction-in-force (RIF) for programs that are not mandatory, did not receive funding through the One Big Beautiful Bill Act, or are not consistent with the Trump administration’s agenda.
While essential services and mandatory spending programs, like Medicare, Medicaid and Social Security for example would largely continue to remit most regular funding, the staff working on these programs could still be furloughed. For example, staff working on social security number verification could be furloughed, making it difficult to get a mortgage or a loan should a shutdown occur. Additionally, in the context of Medicaid, administrative approvals and pending regulatory activity could also be slowed. The Trump administration maintains some discretion in staff furloughs for mandatory programs through its execution of the contingency plans, but to the extent there are furloughs, it could impact the implementation of initiatives requiring the Federal government’s approval. On any given day, New York has dozens of Medicaid approvals pending with the Centers for Medicaid and Medicare Servies (CMS).
Moreover, potential staff furloughs at CMS or the umbrella Health and Human Services (HHS) agencies, could also impact implementation of OBBBA. For example, the newly constituted Rural Healthcare Transformation Program applications are due on November 5, 2025. Other examples of administrative activity that could be delayed include final regulations on the use of Managed Care Taxes and other guidance or regulations necessary for States to make progress on implementation of recently required changes.
At present there does not appear to be a deal to authorize new funding. The House last week passed a continuing resolution, or a temporary spending bill, to maintain operations through November 21, 2025.1 This bill largely was a mere extender, with limited new programs such as increased security funding for members of Congress.
The Senate was unable to secure enough votes to pass the House bill due to a lack of agreement on spending priorities.2 To pass a bill in the Senate, 60 votes are required. There are only 53 Republican Senators, meaning at least seven Democrats will need to agree to the bill, or more if any of the 53 Republican Senators do not vote with their party. Several of the Republican Senators are seeking further reductions to federal spending. Democrat leaders, including Senator Schumer and Minority Leader Jeffries from New York are seeking restorations to healthcare cuts enacted in the OBBBA. The Rockefeller Institute has previously detailed the impacts to New York associated with the OBBBA and associated regulations and guidance from the Trump administration impacting New York’s $300 billion healthcare economy.
With so many moving pieces, it’s complicated to predict exactly what will be included in a final agreement. The need for 60 votes in the Senate and the differing viewpoints on spending has resulted, at least for now, in standoff between Congress and the Trump administration. This debate will play out with the trading of priorities across party lines in the days and weeks to come.
To guide those following the debate in Washington, the table below identifies the major expiring programs, which require immediate federal re-authorization, as well as key dates in the future.
For a detailed summary of healthcare programs impacted by federal actions, please see the Rockefeller Institute of Government’s report and summary detailing those programs and impacts to New York.
| Impacted Program or Area = Expiration Date of Tuesday, September 30 |
Expiration Date |
|---|---|
| Federal Fiscal Year Ends — 2025-09-30 | |
| Fiscal Responsibility Act Spending Caps | 2025-09-30 |
| Authorization of Temporary Assistance for Needy Families (TANF) & Related Programs | 2025-09-30 |
| Electric Vehicle Tax Credits | 2025-09-30 |
| National Flood Insurance Program Authorization | 2025-09-30 |
| Fiscal Year Farm Bill Provisions | 2025-09-30 |
| Medicare, Medicaid, & Other Health Care Extenders | 2025-09-30 |
| Acute Hospital Care at Home Waiver Authorities | 2025-09-30 |
| Authorization of Copayments for hospital care and nursing home care | 2025-09-30 |
| Community Health Center (CHC) Funding | 2025-09-30 |
| Family-to-Family Health Information Centers Program | 2025-09-30 |
| Funding for Quality Measure Endorsement, Input and Selection | 2025-09-30 |
| Low-Volume Adjustment (LVA) Program | 2025-09-30 |
| Medicare Add-On Payments for Ambulance Services | 2025-09-30 |
| Medicare Hospice Survey Funding | 2025-09-30 |
| Medicare Improvement Fund | 2025-09-30 |
| Medicare Telehealth Flexibilities | 2025-09-30 |
| Medicare Work Geographic Index Floor | 2025-09-30 |
| Medicare-Dependent Hospital (MDH) Program | 2025-09-30 |
| National Health Security Programs | 2025-09-30 |
| National Health Service Corps (NHSC) | 2025-09-30 |
| Nursing home care to certain veterans with service-connected disabilities | 2025-09-30 |
| Outreach and Assistance for Low-Income Programs Funding | 2025-09-30 |
| Personal Responsibility Education Program (PREP) | 2025-09-30 |
| Sexual Risk Avoidance Education (SRAE) program | 2025-09-30 |
| Special Diabetes Program (SDP) | 2025-09-30 |
| Defense Production Act (DPA) | 2025-09-30 |
| Cybersecurity Information Sharing Act (CISA) | 2025-09-30 |
| Sexual Risk Avoidance Education (SRAE) program | 2025-09-30 |
| Personal Responsibility Education Program (PREP) | 2025-09-30 |
| Family-to-Family Health Information Centers Program | 2025-09-30 |
| Authorization of Copayments for hospital care and nursing home care | 2025-09-30 |
| Nursing home care to certain veterans with service-connected disabilities | 2025-09-30 |
| Licensure requirements for contractor medical professionals to perform medical disability examinations for the Department of Veterans Affairs under pilot program | 2025-09-30 |
| Various VA programs and authorities | 2025-09-30 |
| Health Care for Homeless Veterans (HCHV) program | 2025-09-30 |
| United States Grain Standards | 2025-09-30 |
| Enhanced ACA Subsidies | 2025-12-31 |
| Various Inflation Reduction Act (IRA) Energy Efficiency Credits | 2025-12-31 |
| National Defense Authorization Act (NDAA) | 2025-12-31 |
| Crop Year Farm Bill Programs | 2025-12-31 |
| Statutory PAYGO Sequester Begins | 2026-01-01 |
| Endowment Tax Expansion Begins | 2026-01-01 |
| IRA Credits for Homes & Alternative Fuel Refueling Property | 2026-06-30 |
| Deduction for Commercial Property | 2026-06-30 |
| Federal Fiscal Year Ends — 2026-09-30 | |
| Surface Transportation Authorization | 2026-09-30 |
| Export-Import Bank Authorization | 2026-09-30 |
| Medicare Physician Payment Increase | 2026-12-31 |
| Debt Ceiling Reached | 2027 (approximate) |
| NYS Medicaid 1115 Waiver | 2027-03-31 |
| De Minimis Entry Privileges Change | 2027-07-01 |
| Federal Fiscal Year Ends — 2027-09-30 | |
| FDA User Fees Programs | 2027-09-30 |
| State SNAP Cost Sharing Begins | 2027-09-30 |
| IRA Clean Energy Tax Provisions | 2027-12-31 |
| Highway Trust Fund Insolvency | 2028 (approximate) |
| Federal Fiscal Year Ends — 2028-09-30 | |
| FAA Authorization Expiration | 2028-09-30 |
| Radiation Exposure Compensation Act (RECA) | 2028-12-31 |
| No Tax on Tips and Overtime | 2028-12-31 |
| Car Loan Deduction | 2028-12-31 |
| Expanded Deduction for Seniors | 2028-12-31 |
| Factory Expensing | 2028-12-31 |
| Trump Account Contributions | 2028-12-31 |
| Federal Fiscal Year Ends — 2029-09-30 | |
| OBBBA Defense, Border Security & Homeland Security Funding | 2029-09-30 |
| Higher SALT Deduction Cap | 2029-12-31 |
| Clean Fuel Production Credit | 2029-12-31 |
| Federal Fiscal Year Ends — 2030-09-30 | |
| Rural Health Transformation Program | 2030-10-01 |
| Social Security Old-Age and Survivors Insurance Trust Fund Exhaustion | 2032 (approximate) |
| Medicare Hospital Insurance (Part A) Trust Fund Exhaustion | 2032 (approximate) |
| OBBBA NASA Artemis & Mars Program Funding | 2032-09-30 |
ABOUT THE AUTHOR(S)
Jillian Kirby Bronner is a special advisor to the New York State Budget Director and a guest author at the Rockefeller Institute of Government.
[1] See for example, https://thehill.com/homenews/house/5512199-house-republicans-stopgap-spending-bill-shutdown/.
[2] See for example, https://www.politico.com/live-updates/2025/09/19/congress/democratic-cr-fails-shutdown-00573163.