What Does a Government Shutdown Mean for Counselors?

The Federal government is headed towards a shutdown unless Congress acts soon. Government funding expires Sunday, October 1, 2023, and lawmakers are still divided.

Each year, Congress must pass spending bills before the October 1^st deadline for the start of a new fiscal year or the government runs out of money to keep functioning. If Congress fails to act before the deadline, there will be a lapse in funding and all nonessential government functions must stop.

Appropriations committees in both chambers are supposed to pass a dozen spending bills that cover different federal agencies. Then the bills must pass both the full House and Senate before going to the president’s desk to be signed into law.

If Congress runs out of time to finish this process, lawmakers can pass a short-term funding extension, to give themselves more time to hash out a full-year deal. While both House and Senate leadership have said that they want to pass a short-term bill, known as a continuing resolution, neither chamber has done so yet. So, if a government shut down does happen, here’s what it will mean for counselors working in or alongside federal agencies:

Centers for Medicaid and Medicare Services (CMS):

• Both Medicare and Medicaid reimbursements and all payments will continue (distinct from discretionary spending supported via appropriations).
• The federal insurance marketplace will remain open.
• The Medicare Drug Price Negotiation Program would likely be slowed down. Many HHS employees that would be acquiring information from the manufacturers are expected to be furloughed.
• The Center for Medicare & Medicaid Innovation (CMMI) will remain in normal operations.
• According to Sec. Becerra, CMS will maintain the staff necessary to make payments to eligible states for the Children's Health Insurance Program (CHIP).
• Employee Retention: 3,236 (49%) of CMS staff will be retained, including 2,928 (45%) who are exempt and 308 (5%) who are excepted staff.
  • A total of 2,928 (45%) CMS staff will be exempt. Exempt CMS staff include one HHS Officer appointed by the President and 2,927 staff who support activities that have funding available during a lapse in appropriations. CMS employees funded from a variety of non-discretionary funding sources are exempt from furlough, such as those funded from the Health Care Fraud and Abuse Control Program, Quality Improvement Organizations, and user fees.
  • A total of 308 (5%) CMS staff are exempt and can legally continue their activities in the absence of appropriations.

 National Institutes of Health (NIH):

• The NIH will be unable to enroll new patients in clinical trials.
• During the 16-day shutdown in 2013, the NIH briefly closed the portal for registering new clinical trials. They have not made it clear if they would potentially do so again.
• Employee Retention: 4,427 (approximately 22.4%) of NIH staff will be retained.  This total includes 177 exempt staff (slightly less than 0.9%), as well as 4,250 (nearly 21.5%) who are excepted.
  • A total of 177 (0.9%) NIH staff will be exempt. This estimate includes the recently appointed Director of the National Cancer Institute (NCI). The other Presidentially appointed position, the Director of the NIH, remains vacant, although a candidate has been nominated. Another 176 employees would be supported by unobligated balances (carryover) from no-year or multi-year accounts such as 21st Century Cures Act (CURES) allocations.  NIH will use the carryover funds to continue support for priority research projects, grants research oversight, and contracting activities that avoid negative impacts that would occur from interruption.
  • A total of 4,250 (about 21.5%) NIH staff are considered excepted and can legally continue their activities in the absence of appropriations. These staff fall into three categories; 1) those whose work is necessary for the safety of human life, 2) those whose work is necessary for the protection of property, and 3) those whose work is “necessarily implied” from the authorized continuation of other activities.

Centers for Disease Control and Prevention (CDC):

• The CDC will continue to monitor disease outbreaks.
• Other public health activities could suffer as more than half of the agency's workers would be furloughed.
• Employee Retention: 6,176 (41%) of CDC staff will be retained including 2,594 (17%) who are exempt and 3,582 (24%) who are excepted.
  • A total of 2,594 (17%) CDC staff will be performing activities without funding issues and are exempt; this includes include staff who are normally paid from or shifted to: administrative funds or user fees appropriated in authorizing legislation, carryover funding or advanced appropriations, or reimbursable funding for which the reimbursement is not paid from funds provided by the lapsed FY 2023 appropriation.  The activities with funding available include work for PEPFAR, CDC's Global AIDS Program, the World Trade Center Health Program, VFC, and EEOICPA.
  • A total of 3,582 (24%) CDC staff are considered excepted and can legally continue their activities in the absence of appropriations. These staff fall into three categories; 1) those whose work is necessary for the safety of human life, 2) those whose work is necessary for the protection of property, and 3) those whose work is "necessarily implied" from the authorized continuation of other activities.

Department of Health and Human Services (HHS Office of the Secretary):

• Employee Retention: 3,383 (59%) of OS staff will be retained, including 2,658 (47%) who are exempt (their activities or position are already funded or otherwise exempted) and 725 (13%) who are excepted (their activities are deemed necessary by implication, or for the safety of human life or protection of property).
  • A total of 2,658 (47%) OS staff will be exempt. Exempt OS staff includes eight HHS Officers appointed by the President and 2,650 staff who support activities that have funding available during a lapse in appropriations. The activities which will continue include OIG's oversight activities, MHA case adjudication; OCR HIPAA related investigations, and OGA's support of the President's Emergency Plan for AIDS Relief initiative. DAB will continue to provide administrative hearings and appeals and Center for Tobacco Products decisions, Federal Food, Drugs, and Cosmetic, and OS will continue Patient Centered Outcomes Research and the Physician's Technical Advisory Committee activities.
  • A total of 725 (13%) OS staff are considered excepted and can legally continue their activities in the absence of appropriations. These staff fall into three categories; 1) those whose work is necessary for the safety of human life, 2) those whose work is necessary for the protection of property, and 3) those whose work is "necessarily implied" from the authorized continuation of other activities or the need to phase down and suspend operations.

The ACA Government Affairs and Public Policy team will continue to monitor the situation and update you as issues arise. If you have questions or would like to become involved in ACA’s advocacy efforts, you can contact the ACA Government Affairs and Public Policy team at advocacy@counseling.org.