How providers can prepare for new 47-Day SSL/TLS certificates

In April 2025, the CA/Browser Forum (CA/B Forum) approved Ballot SC-081v3, reducing the maximum validity of SSL/TLS certificates. Starting in March 2026, the lifespan of public SSL/TLS certificates will begin decreasing from the current 398 days to 47 days by March 2029.

This will greatly affect healthcare IT teams, since certificates will need more frequent renewal, validation data will expire faster, and manual management will become more difficult. 

However, HIPAA compliant email solutions, like Paubox, eliminate the need for TLS certificate management altogether, simplifying compliance and safeguarding patients’ protected health information (PHI).

How shorter SSL/TLS certificates affect HIPAA compliance

The Health Insurance Portability and Accountability Act (HIPAA) requires healthcare entities and business associates to ensure the confidentiality, integrity, and availability of electronic PHI. TLS is a critical component in meeting the [HIPAA] Security Rule’s transmission security standard,” explains A Comparative Study of Modern HTTPS Implementations Evaluating the Security Efficacy of TLS Protocols.

TLS certificates encrypt data in transit across patient portals, telehealth platforms, electronic health record (EHR) systems, APIs, and email. Without proper SSL/TLS management, these systems could become vulnerable to cyberattacks, data breaches, or service interruptions.

Security risks

If a patient portal fails to load because its certificate has expired, patients may bypass unsafe connections, possibly exposing their PHI. 

Similarly, telehealth sessions could be interrupted, delaying care and potentially leading to a data breach. Even APIs that connect EHR systems or transmit data from medical devices could fail, preventing secure communication.

In these cases, an expired certificate creates gaps in data protection, which could result in a costly data breach. According to IBM’s cybersecurity report, the average global cost of a healthcare data breach increased to $4.88 million, the largest increase since the start of the pandemic.

Since HIPAA mandates that PHI must be encrypted in transit, any interruption in TLS protection can be interpreted as a failure to implement required technical safeguards. The costs of a HIPAA violation are layered, escalating, and legally unavoidable, with the maximum annual cost set at $1,919,173.

Go deeper: The complete guide to HIPAA violations

Increased workload

Shortened lifespans also require more frequent validation of organizational and domain credentials. Organizations that use OV or EV certificates will need to revalidate their identity multiple times each year to maintain encrypted communications. 

If these validations are not performed in a timely manner, the organization risks non-compliance with HIPAA’s technical safeguards, which mandate the continuous protection of electronic PHI during transmission.

Automation required 

HIPAA compliance now depends on active encryption; however, manually managing certificates won’t be a viable option due to its increased complexity. Large healthcare organizations, especially, will require certificate automation.

The National Cybersecurity Center of Excellence (NCCoE) TLS server certificate management programs reinforce this, showing how certificate automation can help “organizations prevent, detect, and recover from certificate-related incidents.”

Automated certificate management maintains renewals, so encryption isn’t interrupted. It also keeps logs as evidence of compliance during audits.

Why Paubox is superior

• Patient portals: If a clinic experiences an expired SSL certificate on its patient portal and patient can’t access lab results come across security warnings, they might abandon the portal entirely, possibly delaying their care.
• Telehealth platforms: If a hospital’s telehealth platform has a certificate expiration mid-consultation, sensitive video consultations are interrupted, potentially impacting patient care. The doctors must then reschedule appointments, increasing their administrative workload.
• Email communications: If a provider uses TLS certificates for encrypted email and the certificates expire unexpectedly, secure messages cannot be delivered to patients or referral partners, and possibly expose patients’ protected health information (PHI).

Ultimately, expired certificates directly affect patient care, operations, and regulatory compliance.

Automatic encryption

Paubox is the best solution for healthcare organizations facing shorter certificate lifespans. The platform automatically encrypts all messages, so IT teams managing TLS certificates don’t have to manually manage them for email communications. It keeps patient emails, lab results, appointment reminders, and other sensitive communications secure.

Moreover, Paubox removes the risk of expired certificates disrupting email, helping healthcare organizations maintain continuous HIPAA compliance and decreasing operational burden.

For example, a hospital that automates certificate renewals for its telehealth platform can also use Paubox for secure email to maintain continuous encryption, safeguarding PHI during transmission and at rest.

Continuous communication

Secure emails can facilitate care coordination to enhance patient care, improve patient and provider satisfaction, and reduce overall healthcare costs. Patients, providers, and partners can communicate securely, maintaining continuity of care and preventing delays in treatment.

Integrates with existing workflows

Paubox works with existing email clients (Outlook, Gmail, etc.), making it simple for staff to adopt without additional training. This allows large healthcare organizations to send thousands of patient lab results via email daily.

Even with Paubox simplifying email, healthcare organizations still need to manage certificates for other systems, like portals, APIs, devices, and EHR integrations. 

How to prepare for short certificate lifespans

1. Audit current certificates

Healthcare organizations must first identify every SSL/TLS certificate in use, including domains, subdomains, medical devices, and API endpoints. 

2. Implement automation

Invest in certificate management tools that can automatically request, validate, and deploy certificates. 

More specifically, these tools must have the following features:

• Centralized dashboards for monitoring all certificates.
• Automated renewal and deployment scripts.
• Integration with CI/CD pipelines for medical applications and portals.
• Alerts for failed renewals or certificate expirations.

Hospitals using multiple telehealth platforms must implement automation so that if a certificate is renewed, scripts automatically deploy it to all servers and devices. No downtime occurs, and it could help IT teams save time.

3. Plan for phased rollout

The CA/B Forum rollout is phased, with a 200-day maximum in 2026, a 100-day maximum in 2027, and a 47-day maximum in 2029. Organizations should align internal processes with these timelines for a smooth adoption.

4. Coordinate with vendors

Many EHR and telehealth providers rely on certificates for secure connections. HIPAA-covered entities must confirm that their vendors can handle shorter certificate lifespans and automated deployment.

5. Train IT and security staff

Staff should understand new validation requirements, automation, and how to monitor certificate health to prevent compliance or operational issues.

Additional tips for Paubox users

• Organizations must use Paubox for all patient communication, like lab results, appointment reminders, and telehealth instructions.
• Integrate Paubox with existing email workflows to reduce adoption friction.
• Train staff to recognize secure email indicators, helping patients understand that their communications are encrypted.
• Document Paubox usage in HIPAA policies and audits to show compliance without manual TLS oversight. That way, auditors can see that email communications are encrypted automatically, meeting HIPAA requirements without complex certificate tracking.
• Automate email encryption and focus IT resources on portal, API, and device certificate management to reduce overall attack surfaces.

Preparing for the 2026–2029 transition

• 2025: Covered entities must check all certificates and implement automation for operational systems. Use Paubox for all patient email communication.
• 2026-2027: Monitor phased reduction of certificate validity and check that automation handles renewals.
• 2028-2029: Certificates will be 47 days. Validate that automation scripts work. Paubox continues to secure email, freeing IT resources for other necessary tasks.

The transition to 47-day SSL/TLS certificates compels healthcare organizations to adapt to prevent service disruptions, protect PHI, and maintain HIPAA compliance. While portals, telehealth platforms, APIs, and medical devices will require automated certificate management, Paubox email relieves the burden of preserving HIPAA compliant email encryption.

Furthermore, it helps healthcare organizations maintain patient care and improve their overall cybersecurity posture.

FAQs

Can an expired certificate cause a HIPAA violation?

Yes. HIPAA’s Security Rule requires that all PHI in transit be encrypted using “industry-standard mechanisms.” When a certificate expires, browsers, APIs, mobile apps, and backend services may stop enforcing secure TLS connections. Traffic will then downgrade to unencrypted transport or fail entirely.

How often should healthcare organizations review certificates?

Historically, organizations reviewed certificates quarterly or annually. However, with certificate lifespans reducing from 13 months down to 47 days, organizations must continuously monitor their SSL/TLS certificates.

What is a CI/CD pipeline?

CI/CD stands for continuous integration and continuous delivery/deployment. A CI/CD pipeline is an automation framework that builds, tests, and deploys software updates from development to production. 

During every deployment, the pipeline can automatically apply security checks, validate TLS configurations, prevent expired certificates from being pushed into production, rotate keys, and maintain encryption.