Congress Unveils Massive Funding Bill to Avert Shutdown

On Tuesday, congressional negotiators released a sprawling, bipartisan federal funding bill designed to avert another government shutdown by the January 30 deadline, securing year-long appropriations for the Pentagon, HHS, and the departments of Labor and Homeland Security. The bill represents a critical step toward stability in federal health programs, ensuring that key agencies like HHS can continue operations without disruption.

What Is in the 2026 Bipartisan Federal Funding Bill?

Although the package averts another funding lapse after last year’s historic shutdown and preserves critical health agency funding, it has drawn fierce opposition from House and Senate Democrats over the lack of new restraints on Immigration and Customs Enforcement (ICE) funding in the Homeland Security title, according to NBC News.¹

Last fall, when the government entered the longest shutdown in US history,² health care stakeholders warned of significant disruptions to access and delivery of care.³ Although core Medicare operations were expected to continue, key flexibilities—including expanded telehealth coverage, hospital-at-home programs, and home health waivers—were at risk of expiring without congressional action. Ambulance providers also faced potential reimbursement cuts, threatening emergency response capacity, particularly in rural areas. In addition, uncertainty around Affordable Care Act (ACA) marketplace subsidies raised concerns about higher premiums and coverage losses in 2026, underscoring how even a short shutdown could ripple across the health care system.

Now, a 1059-page bipartisan federal funding bill has been designed to avert another government shutdown.¹ The package aims to keep federal agencies operating through September 30 and restore stability after last year’s prolonged funding lapse. However, the Homeland Security and ICE provisions have become a major point of contention, with many House and Senate Democrats signaling opposition to the bill unless it includes new restrictions on ICE. The bill holds ICE funding roughly flat at about $10 billion and incorporates modest Democratic priorities such as $20 million for ICE body-worn cameras and a reduction of enforcement and detention bed funding.

The Role of Incentive Payments in the Spending Bill

The bill signals continued momentum for value-based care and accountable care models (ACOs), offering clinicians and payers a more predictable path to improving patient outcomes and controlling costs.

Accountable for Health (A4H), a nonpartisan national advocacy and policy analysis organization, praised congressional leaders for including an extension of incentive payments for clinicians participating in advanced alternative payment models (advanced APMs) in the spending bill in a statement.⁴

“The advanced alternative payment model bonus started back when MACRA [Medicare Access and CHIP Reauthorization Act] passed in 2015, and since that time, in large part because of the bonus, we've seen a massive increase in the number of clinicians that participate in 2-sided risk models,” Mara McDermott, CEO of A4H, told The American Journal of Managed Care^® in an interview. “I think that that is in part because more models have been available, but in part because the bonus provides some safety for organizations taking 2-sided risk, especially those taking a 2-sided risk for the first time. That bonus has been really critical in terms of getting new organizations and keeping existing organizations participating in these types of models. And again, [it] just provides that based [on] flat funding that can be reinvested in value-based care systems for those organizations that are taking 2-sided risk.”

How Do APM Bonuses Impact Physician Participation in Accountable Care?

A4H highlighted the inclusion of a one-time 3.1% incentive payment for 2026 as a critical signal that Congress intends to sustain momentum toward accountable care. The organization emphasized that stable, meaningful incentives are essential for clinicians who assume responsibility for cost and quality to continue investing in care transformation.

Citing evidence that advanced APMs deliver higher-quality care at lower cost, A4H noted that extending these incentives would support current participants and encourage broader adoption, while reaffirming bipartisan recognition that continued policy support is necessary to advance value-based care in Medicare.

“One big change that we would like to see longer term is for that advanced alternative payment model bonus to be paid closer in time to when an organization participates or a clinician participates in an advanced alternative payment model,” said McDermott. “Right now, there's a 2-year lag between when a clinician participates in the ACO [accountable care organization] and when that clinician receives a check for the bonus for participating. We would like to see that timeline shortened. The other regulatory thing, I would say, that's super important and ongoing is the development of new models at the CMS Innovation Center. Just before the break, we saw the announcement of a new advanced ACO model that presumably would be eligible for advanced APM bonus. I think these things really go hand in hand, encouraging and then creating the new models that clinicians can adopt.”

References

1. Kapur S, Stewart K, Wong S. Congress releases massive funding bill ahead of shutdown deadline as ICE clash looms. NBC News. Updated January 20, 2026. Accessed January 21, 2026. https://www.nbcnews.com/politics/congress/congress-releases-massive-funding-bill-ahead-shutdown-deadline-ice-cla-rcna254968

2. Kapur S, Wong S, Stewart K. Trump signs funding bill into law, ending record-long government shutdown. NBC News. Updated November 12, 2025. Accessed January 21, 2026. https://www.nbcnews.com/politics/congress/house-vote-bill-end-government-shutdown-longest-ever-snap-flights-rcna243438

3. Steinzor P. Government shutdown could disrupt health care access. AJMC. October 1, 2025. Accessed January 21, 2026. https://www.ajmc.com/view/government-shutdown-could-disrupt-health-care-access

4. A4H issues statement on the congressional proposal to extend advanced APM incentives. Accountable for Health. News release. January 20, 2026. Accessed January 21, 2026. https://accountableforhealth.org/a4h-issues-statement-on-the-congressional-proposal-to-extend-advanced-apm-incentives/