Medicaid Coverage Linked to Rise in Telehealth Use, Healthcare Access

Medicaid coverage of telehealth services between 2013 and 2019 was associated with significant increases in telehealth use and healthcare access, but private insurer coverage of telehealth during the same period was not similarly linked to increases in use and access, a recent study shows.

Published in Health Services Research, the study examined the association between state Medicaid and private insurer telehealth coverage requirements, telehealth use, and healthcare access. Researchers analyzed survey data from the 2013-2019 Association of American Medical Colleges Consumer Survey of Health Care Access. The respondents included 4,492 Medicaid-enrolled and 15,581 privately insured adults under 65.

Researchers conducted separate analyses on Medicaid and private insurer telehealth coverage requirements. The primary outcome was the use of live video communication in the past year, and secondary outcomes included same-day appointments, being able to always get needed care, and having enough options for receiving care.

Medicaid telehealth coverage requirements were linked to a 6.01 percentage-point increase in the use of live video communication. However, private telehealth coverage requirements were associated with a 0.27 percentage point increase in the use of live video communication in the past year, which was not statistically significant.

Additionally, states with a Medicaid telehealth coverage requirement throughout the study period had substantially higher rates of telehealth use initially than those that added a policy. Meanwhile, telehealth usage increased and then decreased in all states during the study period, including those that always had a private telehealth coverage law in place, those that never had a law, and those that added a law during the study period.

The study also shows that Medicaid telehealth coverage requirements were associated with a 10.42 percentage-point increase in same-day appointments and an 11.12 percentage-point increase in always being able to access needed care. Private telehealth coverage requirements were linked to a 2.04 and 0.60 percentage-point increase in the two measures, respectively.

Medicaid beneficiaries typically face more barriers to healthcare access than privately insured individuals, including lower access to transportation and greater difficulty in taking time off from work, the study noted.

"Access to covered telemedicine services could alleviate some of these barriers by eliminating the need to travel to see a provider, which may explain in part the larger response to telemedicine coverage among Medicaid enrollees relative to the privately insured in our study," the study authors wrote.

Further, they stated that the study results could help "inform future policymaking efforts as telemedicine visit rates decrease from peak levels and concerns about the spread of infection become less likely to overpower preferences for in-person care."

Following the onset of the COVID-19 pandemic, states expanded telehealth-related Medicaid policies, particularly for telebehavioral healthcare. A KFF report released earlier this year shows that 40 states took at least one policy action to expand Medicaid coverage of behavioral healthcare provided via telehealth. Of these, 39 expanded the categories of Medicaid behavioral health services eligible for telehealth delivery, and all 40 allowed or expanded Medicaid coverage of audio-only behavioral health services.

Last year, the Government Accountability Office (GAO) noted the rise in telehealth use among Medicaid beneficiaries. GAO studied telehealth data from five states that had a similar increase between March 2020 and February 2021 and found that 32.5 million healthcare services were delivered via telehealth, significantly higher than the 2.1 million a year prior.

The GAO urged states to collect information regarding the quality of telehealth that Medicaid beneficiaries receive and take the steps needed to enhance care based on this information.