The use of telehealth — for instance, to provide specialty care in remote areas — is not new. Its use has increased over the years, along with the development of technologies to enhance quality and accessibility. Now, the COVID-19 pandemic has magnified the importance of telehealth across the health care system, including in Medicaid.
Each state has its own laws and reimbursement policies for telehealth. Within those limits, Medicaid agencies can determine which types of populations can be served, the range of covered services, qualified technologies, the geographic regions permitted, and payment rates and policies. The COVID-19 public health emergency has led all states to expand telehealth access, with a special emphasis on behavioral health, reproductive and maternal and child health, dentistry, physical and occupational therapy, and pediatrics.
We do not yet know whether expanded use of telehealth will continue beyond the COVID-19 public health emergency. In this blog post, we report on our examination of provisions contained in 2018–2019 contracts from 38 states and the District of Columbia that pertain to telehealth, using the Commonwealth Fund’s Medicaid managed care contract database.
A review of the data suggests that prior to the COVID-19 pandemic, states already showed a robust interest in the use of mobile technology to improve quality, access, and patient health. All contracts contain at least some reference to telehealth; many states discuss at length their expectations regarding contractors’ use of telehealth. There is widespread interest for certain purposes, including: behavioral health, care for special-needs children, rural health, monitoring health status for patients with conditions like congestive heart failure, and postdischarge care, especially for patients with a history of frequent hospitalization. States also anticipate use of telehealth to ensure that primary care network providers have access to specialized consultation services. For example, New Mexico’s contract requires contractor participation in the state’s Project ECHO program, which provides telehealth specialty consultation services to underserved communities and health care providers working in remote areas. Kansas similarly requires contractors to cover “telementoring” services by medical specialists who assist both patients and providers, thereby extending specialist services into underserved populations and communities.
Despite this high degree of state interest in telehealth, it may remain underused in Medicaid. There is some evidence showing the value of certain types of mobile technology for Medicaid beneficiaries. But as a general matter, less attention has been focused on the overall question of use of telehealth for the low-income population. For less affluent patients, mobile technology companies have identified several barriers to expansion, including a limited rate of return from direct marketing to poor customers, a sense that low-income patients are not tech savvy, or concerns that additional requirements imposed by Medicaid might limit profitability.
Thus, while Medicaid will pay for adapting and using telehealth services, and the federal government has encouraged its adoption, actual use may spread somewhat slowly. Expanding telehealth use might depend on the degree to which states move toward more explicit contract expectations. This review indicates that Medicaid programs are evolving along with the overall trend of increasing use of telehealth in health care. Strategies for aiding this shift include the development of financial incentives and providing ongoing opportunities for information-sharing across states, managed care organizations, and health professional organizations. Adoption of telehealth also may depend on the extent to which the Centers for Medicare and Medicaid Services pursues telehealth innovation by using its pilot and demonstration authority to encourage adoption, especially for specific populations like high-risk pregnant women or patients with serious health conditions who require uninterrupted access to comprehensive care and patient support. Telehealth done well could increase the use of both primary and specialized services among population groups facing the highest health risks.